慢性阻塞性肺疾病和重叠阻塞性睡眠呼吸暂停的斑点追踪超声心动图,使用 SOMNOcheck micro

Speckle tracking echocardiography in chronic obstructive pulmonary disease and overlapping obstructive sleep apnea

Carmen Pizarro 1Fabian van Essen 1Fabian Linnhoff 1Robert Schueler 1Christoph Hammerstingl 1Georg Nickenig 1Dirk Skowasch 1Marcel Weber 1Affiliations expand

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Abstract

Background: COPD and congestive heart failure represent two disease entities of growing global burden that share common etiological features. Therefore, we aimed to identify the degree of left ventricular (LV) dysfunction in COPD as a function of COPD severity stages and concurrently placed particular emphasis on the presence of overlapping obstructive sleep apnea (OSA).

Methods: A total of 85 COPD outpatients (64.1±10.4 years, 54.1% males) and 20 controls, matched for age, sex, and smoking habits, underwent speckle tracking echocardiography for LV longitudinal strain imaging. Complementary 12-lead electrocardiography, laboratory testing, and overnight screening for sleep-disordered breathing using the SOMNOcheck micro(®) device were performed.

Results: Contrary to conventional echocardiographic parameters, speckle tracking echocardiography revealed significant impairment in global LV strain among COPD patients compared to control smokers (-13.3%±5.4% vs -17.1%±1.8%, P=0.04). On a regional level, the apical septal LV strain was reduced in COPD (P=0.003) and associated with the degree of COPD severity (P=0.02). With regard to electrocardiographic findings, COPD patients exhibited a significantly higher mean heart rate than controls (71.4±13.0 beats per minute vs 60.3±7.7 beats per minute, P=0.001) that additionally increased over Global Initiative for Chronic Obstructive Lung Disease stages (P=0.01). Albeit not statistically significant, COPD led to elevated N-terminal pro-brain natriuretic peptide levels (453.2±909.0 pg/mL vs 96.8±70.0 pg/mL, P=0.08). As to somnological testing, the portion of COPD patients exhibiting overlapping OSA accounted for 5.9% and did not significantly vary either in comparison to controls (P=0.07) or throughout the COPD Global Initiative for Chronic Obstructive Lung Disease stages (P=0.49). COPD-OSA overlap solely correlated with nocturnal hypoxemic events, whereas LV performance status was unrelated to coexisting OSA.

Conclusion: To conclude, COPD itself seems to be accompanied with decreased LV deformation properties that worsen over COPD severity stages, but do not vary in case of overlapping OSA.

Keywords: chronic obstructive pulmonary disease; left ventricular dysfunction; overlap syndrome; speckle tracking echocardiography.

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(以下为翻译内容,可能会有出入,以上原文为准!文章摘自https://pubmed.ncbi.nlm.nih.gov/27182264/


慢性阻塞性肺疾病和重叠阻塞性睡眠呼吸暂停的斑点追踪超声心动图

卡门·皮萨罗 1法比安·范·埃森 1法比安·林霍夫 1罗伯特·舒勒 1克里斯托夫·哈默斯廷尔 1乔治·尼克尼格 1德克·斯科瓦施 1马塞尔·韦伯 1隶属关系 扩张

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抽象的

背景: COPD 和充血性心力衰竭代表具有共同病因特征的全球负担不断增加的两种疾病实体。因此,我们旨在确定 COPD 左心室 (LV) 功能障碍的程度作为 COPD 严重程度阶段的函数,同时特别强调重叠阻塞性睡眠呼吸暂停 (OSA) 的存在。

方法: 共有 85 名 COPD 门诊患者(64.1±10.4 岁,54.1% 男性)和 20 名对照,年龄、性别和吸烟习惯相匹配,接受散斑跟踪超声心动图进行左室纵向应变成像。使用 SOMNOcheck micro(®) 设备对睡眠呼吸障碍进行了补充性 12 导联心电图检查、实验室测试和夜间筛查。

结果: 与传统的超声心动图参数相反,斑点跟踪超声心动图显示,与对照组吸烟者相比,COPD 患者的整体 LV 应变显着受损(-13.3%±5.4% 对 -17.1%±1.8%,P=0.04)。在区域水平上,COPD 患者的心尖室间隔 LV 应变降低(P=0.003)并与 COPD 严重程度相关(P=0.02)。关于心电图结果,COPD 患者的平均心率显着高于对照组(每分钟 71.4±13.0 次对每分钟 60.3±7.7 次,P=0.001),并且比全球慢性阻塞性肺疾病倡议分期还增加(P =0.01)。尽管没有统计学意义,COPD 导致 N 端脑钠肽前体水平升高(453.2±909.0 pg/mL vs 96.8±70.0 pg/mL,P=0.08)。至于睡眠测试,表现出重叠 OSA 的 COPD 患者的比例占 5.9%,与对照组 (P=0.07) 或整个 COPD 慢性阻塞性肺疾病全球倡议 (P=0.49) 相比,没有显着差异。COPD-OSA 重叠仅与夜间低氧血症事件相关,而 LV 体能状态与共存 OSA 无关。

结论: 总而言之,COPD 本身似乎伴随着 LV 变形特性的降低,这种特性在 COPD 严重程度阶段会恶化,但在重叠 OSA 的情况下不会发生变化。

关键词: 慢性阻塞性肺疾病;左心室功能障碍; 重叠综合征; 斑点追踪超声心动图。

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