Evaluation of right ventricular performance and impact of continuous positive airway pressure therapy in patients with obstructive sleep apnea living at high altitude.
Evaluation of right ventricular performance and impact of continuous positive airway pressure therapy in patients with obstructive sleep apnea living at high altitude.
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高原阻塞性睡眠呼吸暂停患者右心室性能评估及持续气道正压通气治疗的影响
DOI：
10.1038/s41598-020-71584-9
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发表时间：
2020-11-19
影响因子：
4.6
通讯作者：
Huang Y
中科院分区：
文献类型：
--
作者：
Chu AA;Yu HM;Yang H;Tian LM;Hu ZY;Jiang N;Xie WX;Huang Y
阻塞性睡眠呼吸暂停综合征（OSAS）可导致右心室（RV）功能和肺血管血流动力学改变。此外，高原缺氧与肺血管收缩有关，高原对OSAS患者肺循环的影响可能进一步改变。我们试图通过二维斑点追踪超声心动图（2D-STE）、实时三维超声心动图（RT-3DE）和心脏生物标志物来评估生活在高海拔地区的OSAS患者的RV形态和功能的改变。我们还评估了持续气道正压通气（CPAP）治疗对RV性能的影响。71例新诊断的OSAS患者和31例对照组被纳入本研究。所有受试者均接受了心脏生物标志物评估，并接受了2D-STE和RT-3DE。45例OSAS患者接受了至少24周的CPAP治疗，并在CPAP治疗前后进行了研究。RT-3DE测量右室容积，计算右室三维射血分数（3D RVEF）。测定收缩期峰值应变。还测量了心脏生物标志物，包括C反应蛋白（CRP）、N末端B型利钠肽前体和心肌肌钙蛋白T。OSAS组右心房容积指数、右心室容积、右心室容积指数、肺动脉收缩压（sPAP）、肺血管阻力（PVR）和血清CRP水平均显著高于对照组，而OSAS组3D RVEF和右心室纵向应变均显著低于对照组。sPAP ≥ 40 mmHg组RV纵向应变较sPAP <40 mmHg组低。RV整体纵向应变和sPAP均与呼吸暂停低通气指数相关。接受6个月CPAP治疗的患者在RV几何形状和性能方面有显著改善。与对照组相比，在中度高海拔地区的OSAS患者中观察到RV结构异常和RV功能障碍。进一步证实了应用CPAP后这些变化的可逆性。
Obstructive sleep apnea syndrome (OSAS) can lead to alterations in right ventricular (RV) performance and pulmonary vascular haemodynamics. Additionally, altitude-related hypoxia is associated with pulmonary vasoconstriction, and the effect of high-altitude on the pulmonary circulation in OSAS patients can be further altered. We sought to assess alterations in RV morphology and function in OSAS patients living at high altitude by way of 2-dimensional speckle tracking echocardiography (2D-STE), real-time 3- dimensional echocardiography (RT-3DE) and cardiac biomarkers. We also evaluate the impact of continuous positive airway pressure (CPAP) treatment on RV performance. Seventy-one patients with newly diagnosed OSAS and thirty-one controls were included in this study. All individuals were assessed for cardiac biomarkers as well as underwent 2D-STE and RT-3DE. Forty-five OSAS patients underwent CPAP therapy for at least 24 weeks and were studied before and after CPAP treatment. RT-3DE was used to measure RV volume, and calculate RV 3D ejection fraction (3D RVEF). Peak systolic strain was determined. Cardiac biomarkers, including C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide, and cardiac troponin T were also measured. Right atrium volume index, RV volume, RV volume index, systolic pulmonary artery pressure (sPAP), pulmonary vascular resistance (PVR) and level of serum CRP were significantly higher in OSAS group, while OSAS patients showed lower 3D RVEF and RV longitudinal strains. Compared to the patients with sPAP < 40 mmHg, RV longitudinal strains in patients with sPAP ≥ 40 mmHg were lower. Both RV global longitudinal strain and sPAP were associated with apnea–hypopnea index. Patients treated with 6 months of CPAP therapy had significant improvement in RV geometry and performance. RV structural abnormalities and RV function impairments were observed in OSAS patients living at moderate high altitude compared to control highlanders. The reversibility of these changes after application of CPAP were further confirmed.
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影响因子：
1.2
作者：
Akashiba, T;Akahoshi, T;Horie, T
通讯作者：
Horie, T
影响因子：
158.5
作者：
Kaneko, Y;Floras, JS;Bradley, TD
通讯作者：
Bradley, TD
DOI：
10.1016/j.echo.2009.11.016
发表时间：
2010-02-01
影响因子：
6.5
作者：
Leibundgut, Gregor;Rohner, Andreas;Handke, Michael
通讯作者：
Handke, Michael
影响因子：
37.8
作者：
Becker, HF;Jerrentrup, A;Peter, JH
通讯作者：
Peter, JH
影响因子：
37.8
作者：
Javaheri, S;Parker, TJ;Roselle, GA
通讯作者：
Roselle, GA