Left ventricular remodeling and systolic function changes in patients with obstructive sleep apnea: a comprehensive contrast-enhanced cardiac magnetic resonance study

Tingyu Li; Qiong Ou; Xiaobing Zhou; Xiaoyu Wei; Anping Cai; Xiaodan Li; Guanmin Ren; Zhicheng Du; Zuogeng Hong; Yilu Cheng; Hui Liu

doi:10.21037/cdt-22-38

Left ventricular remodeling and systolic function changes in patients with obstructive sleep apnea: a comprehensive contrast-enhanced cardiac magnetic resonance study

Cardiovasc Diagn Ther. 2022 Aug;12(4):436-452. doi: 10.21037/cdt-22-38.

Authors

Tingyu Li^{1

2}, Qiong Ou³, Xiaobing Zhou^{2

4}, Xiaoyu Wei⁵, Anping Cai⁶, Xiaodan Li², Guanmin Ren⁷, Zhicheng Du⁸, Zuogeng Hong⁹, Yilu Cheng³, Hui Liu^{2

10}

Affiliations

¹ Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China.
⁴ Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁵ Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
⁶ Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁷ Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
⁸ Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
⁹ Department of Pulmonary and Critical Care Medicine, Zhuhai Hospital of Integrated of Traditional Chinese Medicine and Western Medicine, Zhuhai, China.
¹⁰ Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Abstract

Background: A comprehensive assessment of left ventricular (LV) remodeling and systolic function using contrast-enhanced cardiac magnetic resonance (CMR) imaging in patients with obstructive sleep apnea (OSA) has not yet been reported. This retrospective case-control study aimed to explore and assess the myocardial structure, function, and tissue characteristic changes of LV remodeling in patients with OSA using the CMR method.

Methods: Fifty-one selected participants 32 OSA and 19 non-OSA underwent overnight polysomnography and CMR examination using T1 mapping and feature tracking techniques. Twenty age- and sex-matched healthy controls were also enrolled for comparison between the groups.

Results: Patients were grouped by apnea-hypopnea index (AHI): AHI <5 events/h as non-OSA group (n=19, 40.7±8.0 years), 5-30 events/h as mild-moderate OSA (n=13, 47.8±9.4 years), and >30 events/h as severe OSA (n=19, 39.0±10.0 years). The OSA group had a higher LV mass index (LVMI) to height^2.7 than the non-OSA and healthy control groups (21.0±3.8 vs. 16.4±3.1 and 16.3±3.2 mL/m^2.7, P<0.001). Compared with healthy controls, OSA patients had lower global circumferential strain values, although the LV ejection fraction was preserved. Late gadolinium enhancement was not detected in all participants, whereas the extracellular volume fraction was lower in patients with OSA than in the non-OSA and healthy control groups (24.4%±1.9% vs. 26.2%±2.5%, P=0.006 and 24.4%±1.9% vs. 26.5%±2.3%, P=0.004, respectively). The indexed cellular volume (iCV) of the myocardium was significantly higher in subjects with mild-to-moderate and severe OSA than in those without OSA (14.2±2.3 and 15.8±3.1 vs. 11.6±2.4 mL/m^2.7, P<0.05). On multivariate linear regression analysis of patients with two different models, OSA severity remained significantly associated with increased LVMI (β=0.348, P=0.004 and β=0.233, P=0.048, respectively) and iCV (β=0.337, P=0.004 and β=0.231, P=0.047, respectively) after adjusting for clinical risk factors.

Conclusions: LVMI is elevated in OSA with a normal LV ejection fraction, mainly with cellular hypertrophy. Cellular hypertrophy without focal fibrosis in OSA may be our main finding.

Keywords: Cardiac magnetic resonance (CMR); T1 mapping; feature tracking (FT); obstructive sleep apnea (OSA); ventricular remodeling.