Evaluation of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea by automated function imaging method; an observational study/Obstruktif uyku apneli hastalarda subklinik sol ventrikul sistolik disfonksiyonunun otomatik fonksiyonel goruntuleme yontemiyle degerlendirilmesi: gozlemsel bir calisma

Objective: We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any...

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Published in:Anadolu kardiyoloji dergisi : AKD Vol. 12; no. 4; p. 320
Main Authors: Altekin, Refik Emre, Yanikoglu, Atakan, Karakas, Mustafa Serkan, Ozel, Deniz, Yildirim, Aytul Belgi, Kabukcu, Mehmet
Format: Journal Article
Language:English
Published: KARE Publishing 01-06-2012
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Summary:Objective: We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any confounding disease that can cause myocardial dysfunction. Methods: Twenty-one healthy individuals and 58 OSA patients were included in this observational cross-sectional study. According to the severity of disease, OSA patients were examined in three groups; mild, moderate and severe OSA. Apical 2-, 3- and 4-chamber images were obtained for AFI evaluation. The global systolic longitudinal strain (GLs) values were determined for each view, and averages of these were used in comparison of the patient groups. One-way ANOVA, Kruskal-Wallis, Pearson correlation tests and linear regression analysis were used for statistical analysis. Results: The GLs values of the OSA patients were lower than of the healthy individuals and these values were decreased along with the OSA severity (Healthy:-25.58 [+ or -] -2.16%, Mild:-23.93 [+ or -] -3.96%, Moderate:-21.27 [+ or -] -2.60%, Severe:-16.94 [+ or -] -2.66%, respectively). The difference was significant between moderate OSA patients and healthy individuals, and significant between severe OSA patients and all other groups (p<0.03). The apnea-hypopnea index was found to be correlated with the GLS (p=-0.659, 95% CI: 0.09-0.17, p<0.001). Conclusion: Longitudinal LV mechanics in OSA patients with normal LVEF are deteriorated in the subclinical stage being associated with the severity of disease. AFI can be used as an effective and safe method in the determination of subclinical myocardial dysfunction in OSA patients, because it is semi-automated and easy to use with a short analysis time. (Anadolu Kardiyol Derg 2012; 12:320-30) Key words: Obstructive sleep apnea, speckle tracking echocardiography, myocardial strain, regression analysis Amac: Sol ventrikul ejeksiyon fraksiyonu normal ve miyokart fonksiyonlarini etkileyecek ek hastaligi bulunmayan, obstruktif uyku apneli (OUA) hastalarda, subklinik sol ventrikul sistolik disfonksiyonunu, iki boyutlu benek izleme ekokardiyografi teknigine dayanan, otomatik fonksiyonel goruntuleme yontemi (OFG) ile degerlendirmeyi amacladik. Yontemler: Gozlemsel enine-kesitli calismamiza 21'i saglikli, 58'i OUA hastasi olan toplam 79 kisi alindi. OUA'li hastalar hastaligin ciddiyetine gore hafif, orta ve agir olarak 3 gruba ayrildi. OFG degerlendirmesi icin sol ventrikulun apikal 2-, 3-, 4-bosluk goruntuleri kullanildi. Ilgili bosluklara ait sistolik longitudinal deformasyon degerlerinin aritmetik ortalamasi olan, global longitudinal deformasyon degerleri gruplar arasinda karsilastirildi. Istatistiksel analiz icin tek -yonlu ANOVA, Kruskal-Wallis, Pearson korelasyon testleri ve dogrusal regresyon analizi kullanildi. Bulgular: Saglikli gruba gore hafif OUA grubundan itibaren hastaligin ciddiyeti ile global longitudinal deformasyon degerleri azalmaktaydi (Saglikli: -%25.58 [+ or -] -2.16, Hafif OUA: -%23.93 [+ or -] -3.96, Orta OUA: -%21.27 [+ or -] -2.60, Ciddi OUA: -%16.94 [+ or -] -2.66). Orta OUA grubundan itibaren gruplar arasi fark anlamliydi (p<0.03). Agir OUA grubunun degerleri tum gruplardan dusuk bulundu. Global longitudinal deformasyon degerleri apne hipopne indeksi (AHI) ile iliskili bulundu (beta=-0.659, 95% GA: 0.09-0.17, p<0.001). Sonuc: Sol ventrikul ejeksiyon fraksiyonu normal OUA'li hastalarda miyokardin longitudinal fonksiyonlari hastaligin ciddiyetine bagli olarak subklinik evrede bozulabilir. AFI yontemi yari otomatik olmasi ve kullanim kolayliginin yanisira kisa analiz suresi sayesinde, OUA'li hastalarda miyokart fonksiyonlarinin degerlendirilmesinde mevcut ekokardiyografik yontemlere ek olarak, etkili ve guvenilir bir yontem olarak kullanilabilir. (Anadolu Kardiyol Derg 2012; 12:320-30) Anahtar kelimeler: Obstruktif uyku apne, benek izleme ekokardiyografi, miyokardiyal deformasyon, regresyon analizi
ISSN:1302-8723
DOI:10.5152/akd.2012.096