Potential role of CPAP treatment on right ventricular function in patients with heart failure and OSA
G Severini, G Armentaro, M Rizza, F Capilupi, V Condoleo, C A Pastura, M R Scarcelli, F Maruca, S Miceli, A SciacquaAbstract
Introduction
Obstructive Sleep Apnea (OSA) represents a highly prevalent comorbidity in patients with left ventricular heart failure (LVHF) and emerging evidence demonstrates that OSA induces right ventricular (RV) structural and functional changes that represent a poor prognosis factor. Recent studies have revealed that CPAP therapy, improves RV performance, showing a potential role in preserving RV function in patients with OSA and LVHF.
Purpose
The objective of this study is to evaluate the potential effect of CPAP therapy on the incidence of right ventricular dysfunction (RVD), evaluated as incidence of TAPSE<17 mm, in a cohort of patients with chronic LVHF and new diagnosis of moderate to severe OSA during a mean follow-up of 3.6 years.
Methods
In this retrospective, single-centre observational study a total of 230 outpatients were enrolled and underwent clinical, laboratory and echocardiographic evaluation. Patients with HF NYHA IV, worsening HF in the last 6 months, TAPSE<17 mm at baseline and eGFR<15 ml/min/1,73m2 were excluded. Variables that correlated significantly with the onset of RVD were included in a multivariate Cox regression model to calculate the hazard ratio (HR) for the incidence of RVD.
Results
After a 7-day CPAP titration period, two groups were defined: 97 patients demonstrated good adherence to therapy (>4hours/night) and good tolerability choosing to continue CPAP therapy added to optimal medical therapy (OMT) (CPAP group), while the remaining 133 patients received only OMT (No-CPAP group). The groups were comparable for age and sex, median age was 68.3±9.4 years. Regarding polygraphic parameters AHI (26.9±11.6 vs 36.3±16.9 p<0.001) and ODI index (24.8±12.1 vs 34.0±19.0 p<0.001) at baseline was higher in CPAP group. The groups were comparable for RVOTp, Right Atrium Area, TAPSE and s-PAP value; in contrast Left ventricular ejection fraction (LVEF) (45.8±8.0 vs 49.6±8.1 p<0.001) and GLS% (-12.0±2.6 vs -14.3 ±4.1 p<0.001) value were significantly worse in CPAP untreated group. In CPAP group we observe an higher prevalence of CKD (30.8% vs 62.9% p=0.001) and obesity (38.4% vs 62.9% p=0.001); additionally medical therapies differs for GLP1-RAs (15.0% vs 25.8% p=0.043) and SGLT2i (31.68% vs 64.9% p<0.001) utilization, prevalent in CPAP group. The incidence of RVD in the entire population was 12.2 events/100 patients-year. Of these, 6.3 events/100 patients-year were observed in the CPAP group, while 9.8 events/100 patients-year were reported in the other group (p<0.001). A multivariate analysis model demonstrated that CPAP therapy were associated with a risk reduction of RVD incidence of 59% (HR 0.41; p<0.001), in contrast patients affected by CKD showed a 6.98 fold higher risk of RVD incidence (HR 6.98, p<0.001).
Conclusion
This study confirms the beneficial effect of CPAP therapy added to OMT in patients with LVHF and OSA, in reducing the incidence of RVD during 3.6 years follow-up.