Abstract
Background
The study aim was to determine whether phasic left atrial (LA) function of patients
with heart failure with reduced ejection fraction differs between those with obstructive
sleep apnea (OSA) and central sleep apnea (CSA).
Methods
Participation in the Adaptive Servo Ventilation for Therapy of Sleep Apnea in Heart
Failure (ADVENT-HF) trial requires 2-dimensional echocardiographic documentation of
left ventricular ejection fraction ≤ 45% and a polysomnographic apnea hypopnea index
(AHI) ≥ 15 events per hour. Of initial enrollees, we identified 132 patients in sinus
rhythm (82 with predominantly OSA and 50 with CSA). To determine LA reservoir (expansion
index; EI), conduit (passive emptying index; PEI), and booster function (active emptying
index), we blindly quantified maximum and minimum LA volume and LA volume before atrial
contraction.
Results
Each of EI (P = 0.004), PEI (P < 0.001), and active emptying index (P = 0.045) was less in participants with CSA compared with those with OSA, whereas
average left ventricular ejection fraction and LA and left ventricular volumes were
similar. Multivariable analysis identified an independent relationship between central
AHI and LA EI (P = 0.040) and PEI (P = 0.005). In contrast, the obstructive AHI was unrelated to any LA phasic index,
and slopes relating central AHI to EI and PEI differed significantly from corresponding
relationships with obstructive AHI (P = 0.018; P = 0.006).
Conclusions
In these ADVENT-HF patients with heart failure with reduced ejection fraction, all
3 components of LA phasic function (reservoir, conduit, and contractile) were significantly
reduced in those with CSA compared with participants with OSA. The severity of CSA,
but not OSA associated inversely and independently with LA reservoir and conduit function.
Impaired LA phasic function might be consequent to or could exacerbate CSA.
Résumé
Introduction
L’étude avait pour objectif de déterminer si, chez les patients atteints d’insuffisance
cardiaque avec réduction de la fraction d’éjection, la fonction auriculaire gauche
phasique différait entre les patients souffrant d’apnée du sommeil obstructive (ASO)
et ceux souffrant d’apnée centrale du sommeil (ACS).
Méthodes
Pour participer à l’étude « Adaptive Servo Ventilation for Therapy of Sleep Apnea
in Heart Failure » (ADVENT-HF), les patients devaient avoir une fraction d’éjection
ventriculaire gauche ≤ 45 % documentée par échocardiographie bidimensionnelle et un
indice d’apnée et d’hypopnée (IAH) ≥ 15 événements par heure selon les résultats polysomnographiques.
Parmi l’ensemble des patients initialement inscrits à l’étude, nous avons recensé
132 cas de rythme sinusal (82 patients chez qui l’ASO prédominait et 50 chez qui l’ACS
prédominait). Pour déterminer les indices des fonctions de réservoir (indice d’expansion),
de conduite (indice de vidange passive) et de contraction (indice de vidange active),
nous avons calculé à l’insu les volumes maximum et minimum de l’oreillette gauche,
ainsi que le volume avant la contraction auriculaire.
Résultats
Les indices d’expansion (p = 0,004), de vidange passive (p < 0,001) et de vidange active (p = 0,045) étaient moindres chez les patients atteints d’ACS par rapport à ceux atteints
d’ASO, tandis que la fraction d’éjection ventriculaire gauche moyenne et les volumes
de l’oreillette et du ventricule gauches étaient semblables. L’analyse multivariée
a permis d’établir une relation indépendante entre l’IAH centrale et les indices d’expansion
(p = 0,040) et de vidange passive (p = 0,005) de l’oreillette gauche. En revanche, l’IAH obstructive ne présentait aucune
relation avec les indices phasiques de l’oreillette gauche, et les courbes établissant
le lien entre l’IAH centrale et les indices d’expansion et de vidange passive différaient
de façon significative de celles observées pour l’IAH obstructive (p = 0,018; p = 0,006).
Conclusions
Dans le cadre de l’étude ADVENT-HF menée auprès de patients atteints d’insuffisance
cardiaque avec réduction de la fraction d’éjection ventriculaire gauche, les valeurs
observées pour les trois composantes de la fonction phasique auriculaire gauche (fonctions
de réservoir, de conduite et de contraction) étaient significativement inférieures
chez les patients atteints d’ACS par rapport à ceux atteints d’ASO. Contrairement
à l’ASO, la gravité de l’ACS était inversement associée, de manière indépendante,
à une baisse des indices d’expansion et de vidange passive (fonctions de réservoir
et de conduite). Ce dysfonctionnement phasique pourrait être une conséquence de l’ACS,
ou encore constituer un facteur d’exacerbation de cette dernière.
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Article info
Publication history
Published online: February 12, 2016
Accepted:
February 9,
2016
Received:
December 23,
2015
Footnotes
See page 1409 for disclosure information.
Clinical Trial Registration: www.clinicaltrials.gov NCT01128816.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
