P948Right ventricular end systolic pressure and correlation with sleep related disorders in patients with chronic heart failure


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Abstract

Background: Right ventricular end systolic pressure (RVESP) can be elevated in patients with systolic and diastolic left ventricular dysfunction in absence of pulmonary disease, i.e. due to postcapillary pulmonary hypertension because of congestion. Sleep apnea is a frequent comorbidity in patients with heart failure. The aim of this study was to investigate, whether there is a correlation between sleep apnea and elevated RVESP.Methods: We studied 113 patients with heart failure and clinical suspicion of sleep apnea using polygraphy and echocardiography determinating RVESP, ejection faction (EF), mean heart frequency, left ventricular enddiastolic diameters (LVEDD), apnea hypopnea index (AHI) and body mass index. Pat. with severe mitral regurgitation were excluded. The relationship between those parameters was examined using nonparametric tests.Results: 58 pat. showed no sleep related disorder (AHI<15), further 55 (48.6%) had signs of sleep apnea (AHI >15). The patient group with AHI more than 15 showed a significant (p<0.1) higher RVESP (mean value: 43.4±2.5 SEM vs. 35±1.4 SEM mmHg) and a significant lower oxygen desaturation index (7.08±1.4 vs. 26.46±2.5SEM). There was no significant difference in left ventricular ejection fraction 30.85 vs. 32.4 %, LVEDD (61 vs. 61.3mm), BMI (28.54 vs. 30.37) and only an insignificant difference in mean heart frequency (64.8 vs. 67.8 bpm). Patients with a RVESP of more than 50 mmHg had a significant higher AHI than patients with lower RVESP (23,9±3,2SEM vs. 15,01±1,4SEM mmHg).Conclusion: Sleep apnea is often not suspected in absence of classic symptoms and morphologic profile but it remains a frequent disease in patients with chronic heart failure. Especially in patients with ejection fraction reduced to 35% or less, RVESP shows positive correlation to the severity of sleep apnea (AHI). In conclusion, echocardiography might be a helpful parameter for the detection of sleep related disorders. Furthermore it might be an efficient method for the evaluation of therapy efficiency in patients with severe heart failure and associated sleep disorders in long term follow up

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