Endothelial Dysfunction in Acute Myocardial Infarction: A Complex Association With Sleep Health, Traditional Cardiovascular Risk Factors and Prognostic Markers

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-01-28 DOI:10.1002/clc.70080

Mohamed Ali Hbaieb, Salma Charfeddine, Tarak Driss, Laurent Bosquet, Benoit Dugué, Ahmed Makni, Mouna Turki, Leila Abid, Omar Hammouda

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Abstract

Background

Endothelial function (EndFx) is a core component of cardiovascular (CV) health and cardioprotection following acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).

Hypothesis

AMI patients experience endothelial dysfunction (EndDys), associated with traditional CV risk factors and sleep patterns. EndFx may also predict short and mid-term outcomes.

Methods

EndFx was assessed in 63 patients (56.2 ± 7.6 years) using the Endothelium Quality Index (EQI). Sleep quality and quantity were evaluated using objective (actigraphy) and subjective (Pittsburgh Sleep Quality Index questionnaire) measures. Cardiorespiratory fitness was quantified through the 6-min walking test. Cardiac function was assessed using the left ventricular ejection fraction.

Results

Following AMI, patients tended to experience EndDys (EQI = 1.4 ± 0.7). A severe EndDys was observed in 23.8% of patients (n = 15), while a mild EndDys was present in 63.49% (n = 40). Furthermore, EndDys was significantly associated with traditional CV risk factors (i.e., low physical activity level [12.8%], age [−4.2%], and smoking [−0.7%]) (R² adjusted = 0.50, p < 0.001). Patients with EndDys had poor sleep quality (p = 0.001) and sleep efficiency (p = 0.016) compared to healthy persons. Patients with severe EndDys exhibited lower cardiorespiratory fitness compared to those with healthy EndFx (p = 0.017). Furthermore, during a follow-up period (nearly 4 months) following PCI, major adverse cardiac events were observed in four patients with severe EndDys.

Conclusions

Our results emphasize the importance of adequate sleep and an active lifestyle, notably physical activity practice, as modifiable elements to enhance EndFx, which is regarded as a predictive tool following AMI. However, other factors remain to be elucidated as predictors of CV risk.

Trial Registration

The study protocol was registered in the Pan African Clinical Trial Registry under the trial ID: PACTR202208834230748.

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急性心肌梗死的内皮功能障碍：与睡眠健康、传统心血管危险因素和预后标志物的复杂关联

背景：内皮功能（EndFx）是急性心肌梗死（AMI）经皮冠状动脉介入治疗（PCI）后心血管（CV）健康和心脏保护的核心组成部分。假设：AMI患者经历内皮功能障碍（EndDys），与传统的心血管危险因素和睡眠模式相关。EndFx也可以预测短期和中期的结果。方法：采用内皮质量指数（EQI）对63例患者（56.2±7.6岁）的EndFx进行评估。采用客观（活动记录仪）和主观（匹兹堡睡眠质量指数问卷）评估睡眠质量和睡眠量。通过6分钟步行测试量化心肺适能。使用左心室射血分数评估心功能。结果：AMI后患者易出现EndDys （EQI = 1.4±0.7）。重度EndDys患者占23.8% (n = 15)，轻度EndDys患者占63.49% （n = 40）。此外，EndDys与传统的心血管危险因素（即低体力活动水平[12.8%]，年龄[-4.2%]和吸烟[-0.7%]）显著相关（R2调整= 0.50,p）。结论：我们的研究结果强调了充足的睡眠和积极的生活方式，特别是体力活动，作为可改变的因素对提高EndFx的重要性，这被认为是AMI后的预测工具。然而，其他因素作为心血管风险的预测因素仍有待阐明。试验注册：该研究方案已在泛非临床试验注册中心注册，试验ID: PACTR202208834230748。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.