收缩期前波与阻塞性睡眠呼吸暂停综合征中亚临床左心室功能障碍的关联

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中文摘要

背景： 阻塞性睡眠呼吸暂停综合征（OSAS）与亚临床心肌功能障碍相关。本研究旨在评估确诊OSAS患者中收缩期前波（PSW）与左心室整体纵向应变（GLS）之间的关联，并确定PSW是否可作为亚临床左心室收缩功能障碍的简易超声心动图标志物。
方法： 前瞻性纳入103例经多导睡眠图确诊的OSAS患者。根据PSW存在与否对患者进行分类。比较两组之间的临床特征、多导睡眠图检查结果、常规超声心动图参数以及通过二维斑点追踪超声心动图获得的左心室GLS。进行单变量和多变量logistic回归分析，以确定与PSW存在独立相关的因素。
结果： 57例患者被分类为PSW阳性，46例为PSW阴性。PSW患者的呼吸暂停低通气指数值显著更高，重度OSAS的患病率也更高。尽管两组的左心室射血分数均保持在正常范围内，但PSW阳性患者的GLS显著受损（-16.1 ± 1.9% 对 -18.1 ± 1.3%，p < 0.001）。在多变量logistic回归分析中，调整呼吸暂停低通气指数、体重指数、腰围和β受体阻滞剂使用后，GLS仍与PSW存在独立相关（OR，2.19；95% CI，1.52-3.15；p < 0.001）。在可检测到PSW的患者中，PSW峰值速度的中位数为65 cm/s（四分位距，57-70 cm/s），且与GLS或呼吸暂停低通气指数无显著相关性。
结论： 在OSAS患者中，PSW的存在与GLS受损独立相关，尽管左心室射血分数保留。这些发现表明，PSW可能作为该人群中亚临床左心室收缩功能障碍的一种简单、无创且易于获得的超声心动图标志物。收缩期前波（PSW）已被提出作为左心室功能障碍的简易超声心动图标志物。其与阻塞性睡眠呼吸暂停（OSA）中心肌变形的关系仍不确定。OSA患者接受了全面的经胸超声心动图检查，包括PSW的多普勒评估和整体纵向应变（GLS）的斑点追踪分析。根据PSW状态比较临床、多导睡眠图和超声心动图参数。PSW可能作为阻塞性睡眠呼吸暂停患者中亚临床左心室收缩功能障碍的一种简单且易于获得的超声心动图标志物。

英文摘要

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with subclinical myocardial dysfunction. This study aimed to evaluate the association between presystolic wave (PSW) and left ventricular global longitudinal strain (GLS) in patients with confirmed OSAS and to determine whether PSW may serve as a simple echocardiographic marker of subclinical left ventricular systolic dysfunction.
METHODS: A total of 103 patients with polysomnography-confirmed OSAS were prospectively enrolled. Patients were classified according to the presence or absence of PSW. Clinical characteristics, polysomnographic findings, conventional echocardiographic parameters, and left ventricular GLS obtained by two-dimensional speckle-tracking echocardiography were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with the presence of PSW.
RESULTS: Fifty-seven patients were classified as PSW-positive and 46 as PSW-negative. Patients with PSW had significantly higher apnea-hypopnea index values and a greater prevalence of severe OSAS. Although left ventricular ejection fraction remained within the normal range in both groups, GLS was significantly impaired in PSW-positive patients (-16.1 ± 1.9% vs. -18.1 ± 1.3%, p < 0.001). In multivariable logistic regression analysis, GLS remained independently associated with PSW presence after adjustment for apnea-hypopnea index, body mass index, waist circumference, and beta-blocker use (OR, 2.19; 95% CI, 1.52-3.15; p < 0.001). Among patients with detectable PSW, the median peak PSW velocity was 65 cm/s (interquartile range, 57-70 cm/s) and was not significantly correlated with GLS or apnea-hypopnea index.
CONCLUSIONS: In patients with OSAS, the presence of a PSW is independently associated with impaired GLS despite preserved left ventricular ejection fraction. These findings suggest that PSW may serve as a simple, non-invasive, and readily available echocardiographic marker of subclinical left ventricular systolic dysfunction in this population. Presystolic wave (PSW) has been proposed as a simple echocardiographic marker of left ventricular dysfunction. Its relationship with myocardial deformation in obstructive sleep apnea (OSA) remains uncertain. Patients with OSA underwent comprehensive transthoracic echocardiography, including Doppler assessment of PSW and speckle-tracking analysis of global longitudinal strain (GLS). Clinical, polysomnographic, and echocardiographic parameters were compared according to PSW status. PSW may serve as a simple and readily available echocardiographic marker of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea.