Heart Failure With Preserved Ejection Fraction-Like Phenotype in Coronary Artery Disease and Obstructive Sleep Apnea: Insights From the RICCADSA Cohort

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2026-06-29 DOI:10.1002/clc.70402

Erik Thunström, Helena Glantz, Aylin Pihtili, Yüksel Peker

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Abstract

Background

Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF-like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity.

Methods

A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea–hypopnea index (AHI) ≥ 15 events/h. HFpEF-like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e′ ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT-proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI).

Results

Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m²; 69.9% met HFpEF-like criteria. Age and obesity were independently associated with HFpEF-like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005–1.033) and ODI (OR 1.030, 95% CI 1.010–1.050) were significant predictors.

Conclusions

HFpEF-like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep-related factors.

Pre-registered Clinical Trial Number

The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige—Research and Development in Sweden; registration no. VGSKAS-4731; April 29, 2005).

Abstract Image

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冠状动脉疾病和阻塞性睡眠呼吸暂停中保留射血分数样表型的心力衰竭：来自RICCADSA队列的见解

背景：心力衰竭伴保留射血分数（HFpEF）与衰老和心脏代谢危险因素密切相关，并经常与阻塞性睡眠呼吸暂停（OSA）共存。我们的目的是调查hfpef样表型在血运重建的冠状动脉疾病（CAD队列）中的患病率和临床相关性，重点是OSA及其严重程度。方法：从RICCADSA队列中共纳入435例左室射血分数保存的患者。OSA定义为呼吸暂停低通气指数(AHI)≥15次/小时。hfpef样表型定义为以下≥2项：充盈压力升高（E/ E′≥15），左心房增大，左心室质量指数升高，肺动脉收缩压升高（≥35 mmHg）， NT-proBNP升高（≥125 pg/mL）。多变量logistic回归分析包括年龄、性别、肥胖、高血压、糖尿病和OSA状态。其他模型将AHI和氧去饱和指数（ODI）作为连续变量进行评估，并评估排除体重指数（BMI）的影响。结果：平均年龄63.6±8.6岁，BMI 28.1±4.1 kg/m2；69.9%符合hfpef类标准。年龄和肥胖与hfpef样表型独立相关，而分类性OSA与之无关。调整后AHI与ODI无独立相关性；然而，在排除BMI的模型中，AHI （OR 1.019, 95% CI 1.005-1.033）和ODI （OR 1.030, 95% CI 1.010-1.050）是显著的预测因子。结论：hfpef样表型在CAD中非常普遍，主要与衰老和肥胖相关。OSA严重程度与心脏重构之间的关系似乎依赖于肥胖，强调了心脏代谢和睡眠相关因素之间的相互作用。预注册临床试验编号：RICCADSA试验已在ClinicalTrials.gov （NCT00519597）和瑞典国家研究注册中心（FoU i Sverige-Research and Development in Sweden，注册号为：1）注册。vgskas - 4731;2005年4月29日)。

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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.