P263Cardiac structural abnormality in acute myocardial infarction patients at high risk of obstructive sleep apnea.


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Abstract

Purpose: The aim of this study was to determine cardiac structural abnormalities by echocardiography in unselected group of acute myocardial infarction (AMI) patients who are at high risk of obstructive sleep apnea (OSA).Methods: We identified AMI patients treated with primary angioplasty who are at high risk of OSA (high risk based on Berlin questionnaire and Epworth sleepiness scale result ≥10). All patients underwent echocardiographic study. Studies were carried out with Philips iE 33 and 2,5-3,5 MHz transthoracic probe. Left ventricular (LV) hypertrophy was defined as LV mass index >95 g/m2 in women and >115 g/m2 in men.Results: 158 consecutive patients were enrolled in the study (mean age was 57,11±8,72 SD, 68% were male). 54 (34,2%) patients were at high risk of OSA. Patients at high risk of OSA had higher body mass index (32,3±4,6 vs. 27 ±3,8 kg/m2; p<0,0001), systolic (149,91±34,2 vs. 128,36±23,57 mmHg; p<0,0001) and diastolic 87,65±17,49 vs. 76,18±12,06 mmHg; p<0,0001) blood pressure on admission. High-risk patients' LV diastolic diameter (52,2±7.3 vs. 48,2±5,1 mm; p=0,01), left atrial diameter (41,3±5,4 vs. 38±4,6 mm; p=0,0001) and interventricular septal thickness (12,6±2,4 vs. 11,5±1,7 mm; p=0,0028) were increased compared with low-risk subjects. The LV mass (300,7±105,7 vs. 237,5±59,6; p=0,0002), and LV mass index (140,3±47,4 vs. 122,8±28,2 g/m2; p=0,023) were significantly higher in high-risk patients. There was no statistically significant difference in LV ejection fraction (49,88±8,73 vs. 49,79±8,75; p=0,953), right ventricular diameter (25,66±3,01 vs. 24,97±3,12; p=0,199), and aortic thickness (32,2±4,7 vs. 31,1±3,7;p=0,261) between low- and high risk patients. LV hypertrophy was present in 64,8% of high risk for OSA and in 61,5% of low risk group (p=NS). In multiple logistic regression analysis LV diastolic diameter >49 mm [OR 3,5 (95% Confidence Interwal): 1,05-11,6; p=0,042], LV mass index >122,6 g/m2 [OR 0,26 95% CI: 0,07-0,94; p=0,04], and interventricular septal thickness >12 mm [OR 4,44 95% CI: 1,15-17,1; p=0,03], history of hypertension [OR 4,42 95% CI: 0,96-20,5; p=0,057], body mass index >30 kg/m2 [OR 6,82 95% CI: 2,33-20; p<0,001], diastolic blood pressure >90 mmHg [OR 6,4 95% CI: 1,58-25,9; p=0,009] were independent risk factors for high risk of OSA.Conclusions: High risk of OSA in AMI patients was associated with increased LV mass, and LV mass index. LV diastolic diameter, LV mass index, interventricular septal thickness, hypertension, body mass index, diastolic blood pressure are all independent risk factors for high risk of OSA.

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