Prognostic roles of obstructive sleep apnea syndrome and right ventricular dysfunction in heart failure patients with preserved ejection

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Objective. To study the prognostic roles of obstructive sleep apnea syndrome (OSAS) and right ventricular dysfunction in the development of heart failure (HF) progression in patients with preserved ejection fraction (HFpEF) during the 12-month follow-up period. Methods. The severity of obstructive breathing disorders during sleep was assessed by the apnea/hypopnea index (AHI). A total of 86 men, median age of 62.0 (41.0; 78.0) years with moderate and severe OSAS (with AHI > 15 per hour) and HF of NYHA class I-III with baseline LVEF of 60% [52; 65]% were enrolled in the study. All patients had the abdominal obesity (WC > 92 cm), body mass index exceeded 30 kg/m2. Serum levels of NT-proBNP were measured using ELISA at baseline. Two-dimensional transthoracic echocardiography with assessment of right ventricular function and 6-minute walk test were performed at baseline and at 12 months. Results. At 12 months of follow-up period all patients were divided into 2 groups: group 1 (n = 33) comprised patients with HF progression, group 2 (n = 53) without it. The concentration of NT-proBNP at baseline was higher by 18% in group 1 than in group 2 (p = 0.024; 338 [168; 678] vs. 278 [177; 815] pg/mL, respectively). The median values of AHI (p < 0.0001) were 46.0 [20.6; 85] per hour in group 1 and 24.0 [21.0; 28.0] per hour in group 2. In group 1 than in group 2 fractional change in the area of the right ventricle (ΔSRV) was less by 9.1% (p = 0.031; 40 [35; 47] vs. 44 [40; 47]%, respectively) and right ventricular myocardial function index (RVSWI, Tey index) was less by 8% (p = 0.022; 0.23 [0.22; 0.25] vs. 0.25 [0.24; 0.26], respectively). Based on ROC-analysis, AHI ≥33.5 episodes per hour (sensitivity 75.8%, specificity 67.9%, AUC = 0.732; p < 0.0001), ΔSRV ≤18.6% (sensitivity 75.8%, specificity 54.7%, AUC = 0.62; p = 0.047) and NT-proBNP ≥311 pg/mL (sensitivity 63.6%, specificity 73.6%, AUC = 0.645; p < 0.0001) were identified as a cut-off values predicting the development of HF progression. The combined evaluation of NT-proBNP and AHI increased the predictive value of the analysis (sensitivity of 82.6%, specificity of 77.1%, and AUС of 0.821; p < 0.0001). Conclusion. Our data suggest that NT-proBNP, AHI and ΔSRV may be used as a diagnostic biomarker for HF progression in patients with preserved ejection fraction (HFpEF) during the 12-month follow-up period. The combined use of NT-proBNP and AHI demonstrated higher diagnostic sensitivity and specificity for prediction of unfavorable course of HF.