Tove Elizabeth Frances Hunt, Gunn Marit Traaen, Lars Aakerøy, Richard John Massey, Christina Bendz, Britt Øverland, Harriet Akre, Sigurd Steinshamn, Jan Pål Loennechen, Kaspar Broch, Thomas Helle-Valle, Øyvind Haugen Lie, Anne Kristine Anstensrud, Kristina H Haugaa, Lars Gullestad, Ole-Gunnar Anfinsen, Svend Aakhus
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We assessed the impact of CPAP treatment on LA and LV size and function in patients with OSA and PAF before and after catheter ablation.</p><p><strong>Methods: </strong>In a randomised controlled trial, we screened patients with PAF for OSA. We enrolled patients with an Apnoea-Hypopnoea Index ≥15/hour. The burden of AF was monitored by an implantable loop recorder in all patients. Patients were then randomised to CPAP treatment or standard care. Transthoracic echocardiography was performed at baseline and after 6 and 12 months to assess LV and LA function and remodelling with advanced echocardiographic imaging techniques.</p><p><strong>Results: </strong>We enrolled 109 patients (63±7 years, body mass index 29.6±4.3, 76% men). 83 patients were scheduled for pulmonary vein isolation (PVI) and 26 for clinical follow-up only. 55 patients were randomised to CPAP and 54 to standard care. The burden of AF decreased significantly in patients who underwent PVI irrespective of treatment with CPAP (p for difference ≤0.001). Patients in the study group had LV ejection fraction (LVEF) and LV global longitudinal strain (GLS) within the normal range, increased LA Volume Index (LAVI), LA volume (by speckle tracking) and decreased LA reservoir strain at baseline. We did not observe any improvement in LVEF, GLS, LAVI, LA volume or LA reservoir strain in either group during the 12 months of follow-up.</p><p><strong>Conclusions: </strong>In patients with PAF and OSA, treatment with CPAP was not associated with reverse LA remodelling within 12 months of follow-up.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"11 2","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529513/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cardiac remodelling in patients with atrial fibrillation and obstructive sleep apnoea.\",\"authors\":\"Tove Elizabeth Frances Hunt, Gunn Marit Traaen, Lars Aakerøy, Richard John Massey, Christina Bendz, Britt Øverland, Harriet Akre, Sigurd Steinshamn, Jan Pål Loennechen, Kaspar Broch, Thomas Helle-Valle, Øyvind Haugen Lie, Anne Kristine Anstensrud, Kristina H Haugaa, Lars Gullestad, Ole-Gunnar Anfinsen, Svend Aakhus\",\"doi\":\"10.1136/openhrt-2024-002718\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Obstructive sleep apnoea (OSA) can cause left atrial (LA) and left ventricular (LV) remodelling, which is linked to atrial fibrillation (AF). 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引用次数: 0
摘要
背景：阻塞性睡眠呼吸暂停（OSA）可导致左心房（LA）和左心室（LV）重塑，这与心房颤动（AF）有关。持续气道正压（CPAP）能否逆转 OSA 和阵发性房颤（PAF）患者的 LA 和左心室重塑尚有待研究。我们评估了导管消融前后 CPAP 治疗对 OSA 和 PAF 患者 LA 和 LV 大小及功能的影响：在一项随机对照试验中，我们对 PAF 患者进行了 OSA 筛查。我们招募了呼吸暂停-低通气指数≥15/小时的患者。所有患者的房颤负荷均由植入式循环记录仪监测。随后，患者被随机分配接受 CPAP 治疗或标准护理。在基线及6个月和12个月后进行经胸超声心动图检查，用先进的超声心动图成像技术评估左心室和左心室的功能和重塑情况：我们共招募了109名患者（63±7岁，体重指数29.6±4.3，76%为男性）。83名患者计划进行肺静脉隔离术（PVI），26名患者仅进行临床随访。55 名患者随机接受 CPAP 治疗，54 名患者接受标准治疗。无论使用 CPAP 治疗与否，接受 PVI 的患者房颤负担明显减轻（差异 p ≤0.001）。研究组患者的左心室射血分数（LVEF）和左心室整体纵向应变（GLS）均在正常范围内，基线时左心室容积指数（LAVI）和左心室容积（通过斑点追踪法）增加，左心室储腔应变减少。在12个月的随访中，我们没有观察到两组患者的LVEF、GLS、LAVI、LA容积或LA储库应变有任何改善：结论：在 PAF 和 OSA 患者中，CPAP 治疗与 12 个月随访期间的逆向 LA 重塑无关。
Cardiac remodelling in patients with atrial fibrillation and obstructive sleep apnoea.
Background: Obstructive sleep apnoea (OSA) can cause left atrial (LA) and left ventricular (LV) remodelling, which is linked to atrial fibrillation (AF). Whether continuous positive airway pressure (CPAP) can reverse LA and LV remodelling in patients with OSA and paroxysmal AF (PAF) has yet to be studied. We assessed the impact of CPAP treatment on LA and LV size and function in patients with OSA and PAF before and after catheter ablation.
Methods: In a randomised controlled trial, we screened patients with PAF for OSA. We enrolled patients with an Apnoea-Hypopnoea Index ≥15/hour. The burden of AF was monitored by an implantable loop recorder in all patients. Patients were then randomised to CPAP treatment or standard care. Transthoracic echocardiography was performed at baseline and after 6 and 12 months to assess LV and LA function and remodelling with advanced echocardiographic imaging techniques.
Results: We enrolled 109 patients (63±7 years, body mass index 29.6±4.3, 76% men). 83 patients were scheduled for pulmonary vein isolation (PVI) and 26 for clinical follow-up only. 55 patients were randomised to CPAP and 54 to standard care. The burden of AF decreased significantly in patients who underwent PVI irrespective of treatment with CPAP (p for difference ≤0.001). Patients in the study group had LV ejection fraction (LVEF) and LV global longitudinal strain (GLS) within the normal range, increased LA Volume Index (LAVI), LA volume (by speckle tracking) and decreased LA reservoir strain at baseline. We did not observe any improvement in LVEF, GLS, LAVI, LA volume or LA reservoir strain in either group during the 12 months of follow-up.
Conclusions: In patients with PAF and OSA, treatment with CPAP was not associated with reverse LA remodelling within 12 months of follow-up.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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