Abstract
ObejctiveObstructive sleep apnoea (OSA) increases left ventricular transmural pressure more than central sleep apnoea (CSA) owing to negative intrathoracic pressure swings. We tested the hypothesis that the severity of OSA, and not CSA, is therefore associated with spheric cardiac remodelling after acute myocardial infarction.MethodsThis sub-analysis of a prospective observational study included 24 patients with acute myocardial infarction who underwent primary percutaneous coronary intervention. Spheric remodelling, calculated according to the sphericity index, was assessed by cardiac magnetic resonance imaging at baseline and 12 weeks after acute myocardial infarction. OSA and CSA [apnoea-hypopnoea index (AHI) ≥ 5/hour] were diagnosed by polysomnography.ResultsWithin 12 weeks after acute myocardial infarction, patients with OSA exhibited a significant increase in systolic sphericity index compared to patients without sleep-disordered breathing (no SDB) and patients with CSA (OSA vs. CSA vs. no SDB: 0.05 ± 0.04 vs. 0.01 ± 0.04 vs. − 0.03 ± 0.03, p = 0.002). In contrast to CSA, the severity of OSA was associated with an increase in systolic sphericity index after accounting for TIMI-flow before percutaneous coronary intervention, infarct size, pain-to-balloon-time and systolic blood pressure [OSA: B (95% CI) 0.443 (0.021; 0.816), p = 0.040; CSA: 0.193 (− 0.134; 0.300), p = 0.385].ConclusionIn contrast to CSA and no SDB, OSA is associated with spheric cardiac remodelling within the first 12 weeks after acute myocardial infarction. Data suggest that OSA-related negative intrathoracic pressure swings may contribute to this remodelling after acute myocardial infaction.Graphic abstract
Highlights
Over recent decades, patient survival after ST-elevation myocardial infarction (STEMI) has improved tremendously due to innovative therapeutic advances in the treatment and management of this condition [1]
This study provides unique insights into the association between Sleep-disordered breathing (SDB) and spheric cardiac remodelling after acute myocardial infarction: firstly, in contrast to the no SDB and central sleep apnoea (CSA) groups, patients with Obstructive sleep apnoea (OSA) exhibited a significant increase in systolic and diastolic sphericity index within 12 weeks after acute myocardial infarction
Left ventricular function is diminished in both CSA and OSA patients after STEMI compared to patients without SDB [25,26,27] and an improvement in apnoea-hypopnoea index (AHI) over time is associated with an improvement in left ventricular function [24]
Summary
Patient survival after ST-elevation myocardial infarction (STEMI) has improved tremendously due to innovative therapeutic advances in the treatment and management of this condition [1]. Postinfarction heart failure resulting from left ventricular remodelling processes remains a major predictor of prognosis [2]. Most cardiac aneurysms after STEMI affect the anterior wall of the left ventricle and are a strong predictor for heart failure and surval after myocardial infarction [3]. Spheric cardiac remodelling can be measured by the sphericity index [7] and is characterised by a decline in left ventricular ejection fraction, and a decrease in 10-year survival after myocardial infarction [5, 8]. The hallmark of OSA is breathing efforts against the occluded pharynx, leading to negative inspiratory pressure swings [10] and to a significantly increased left ventricular transmural wall pressure
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