Nocturnal hypoxemic burden is associated with epicardial fat volume in patients with acute myocardial infarction
- 43 Downloads
Increased epicardial fat volume (EFV) is a common feature of patients with sleep-disordered breathing (SDB), is considered as an established marker of cardiovascular risk, and is associated with adverse cardiovascular events after myocardial infarction (MI).
To investigate the association between different measures of SDB severity and EFV after acute MI, we enrolled 105 patients with acute MI in this study. Unattended in-hospital polysomnography was performed to determine the number of apneas and hypopneas per hour during sleep (apnea-hypopnea index, AHI). To determine nocturnal hypoxemic burden, we used pulse oximetry and applied a novel parameter, the hypoxia load representing the integrated area of desaturation divided by total sleep time (HLTST). Of 105 patients, 56 underwent cardiovascular magnetic resonance to define EFV.
HLTST was significantly associated with EFV (r2 = 0.316, p = 0.025). Multivariate linear regression analysis accounting for age, sex, body mass index, smoking, and left ventricular mass demonstrated that the HLTST was an independent modulator of EFV (B-coefficient 0.435 (95% CI 0.021–0.591); p = 0.015). In contrast, AHI or established measures of hypoxemia did not correlate with EFV.
HLTST, a novel parameter to determine nocturnal hypoxemic burden, and not AHI as an event-based measure of SDB, was associated with EFV in patients with acute MI. Further studies are warranted to confirm the link between nocturnal hypoxemia and EFV and to determine the prognostic value of a more detailed characterization of nocturnal hypoxemic burden in patients with high cardiovascular risk.
KeywordsSleep apnea Hypoxia Epicardial fat Myocardial infarction Magnetic resonance imaging
The authors are grateful for the excellent assistance provided by Astrid Brandl-Novak, Astrid Braune, Ruth Luigart, and Katja Ziczinski.
Dominik Linz, Stefan Colling, Stefan Buchner, and Michael Arzt were responsible for the conception, the delineation of the hypotheses, and the design of the study, the acquisition of funding, data acquisition, the analysis and interpretation of such information, and writing the article, and in its revision prior to submission.
Wolfgang Nußstein, Kurt Debl, Okka W Hamer, and Claudia Fellner were involved in data acquisition, the analysis and interpretation of such information, and the critical revision of the article prior to submission.
Lars Maier, Mathias Hohl, and Michael Böhm were involved in data interpretation and in the critical revision of the article prior to submission.
Compliance with ethical standards
Conflict of interest
Michael Arzt received grant support from ResMed (Martinsried, Germany), Philips Respironics (Murrysville, PA, USA). Michael Arzt and Dominik Linz previously received lecture fees from Philips Respironics (Murrysville, PA, USA) and ResMed (Martinsried, Germany). Stefan Buchner, Wolfgang Nußstein, Mathias Hohl, Michael Böhm, Stefan Colling, Kurt Debl, Okka W Hamer, Claudia Fellner, and Lars S. Maier have no conflicts of interest to disclose.
All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the local institutional ethics committee.
Informed consent was obtained from all individual participants included in the study.
- 2.Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL (2012) Tangredi MM; American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619, 5. https://doi.org/10.5664/jcsm.2172PubMedPubMedCentralGoogle Scholar
- 4.Gellen B, Canouï-Poitrine F, Boyer L, Drouot X, Le Thuaut A, Bodez D, Covali-Noroc A, D’ortho MP, Guendouz S, Rappeneau S, Kharoubi M, Dubois-Rande JL, Hittinger L, Adnot S, Bastuji-Garin S, Damy T (2016) Apnea-hypopnea and desaturations in heart failure with reduced ejection fraction: are we aiming at the right target? Int J Cardiol 203:1022–1028. https://doi.org/10.1016/j.ijcard.2015.11.108CrossRefPubMedGoogle Scholar
- 5.Asano K, Takata Y, Usui Y, Shiina K, Hashimura Y, Kato K, Saruhara H, Yamashina A (2009) New index for analysis of polysomnography, ‘integrated area of desaturation’, is associated with high cardiovascular risk in patients with mild to moderate obstructive sleep apnea. Respiration 78:278–284, 3. https://doi.org/10.1159/000202980CrossRefPubMedGoogle Scholar
- 6.Gottlieb JD, Schwartz AR, Marshall J, Ouyang P, Kern L, Shetty V, Trois M, Punjabi NM, Brown C, Najjar SS, Gottlieb SS (2009) Hypoxia, not the frequency of sleep apnea, induces acute hemodynamic stress in patients with chronic heart failure. J Am Coll Cardiol 54(18):1706–1712. https://doi.org/10.1016/j.jacc.2009.08.016CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Lubrano C, Saponara M, Barbaro G, Specchia P, Addessi E, Costantini D, Tenuta M, Di Lorenzo G, Genovesi G, Donini LM, Lenzi A, Gnessi L (2012) Relationships between body fat distribution, epicardial fat and obstructive sleep apnea in obese patients with and without metabolic syndrome. PLoS One 7(10):e47059. https://doi.org/10.1371/journal.pone.0047059CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Gitsioudis G, Schmahl C, Missiou A, Voss A, Schüssler A, Abdel-Aty H, Buss SJ, Mueller D, Vembar M, Bryant M, Kauczor HU, Giannitsis E, Katus HA, Korosoglou G (2016) Epicardial adipose tissue is associated with plaque burden and composition and provides incremental value for the prediction of cardiac outcome. A clinical cardiac computed tomography angiography study. PLoS One 11(5):e0155120. https://doi.org/10.1371/journal.pone.0155120CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Nerlekar N, Brown AJ, Muthalaly RG, Talman A, Hettige T, Cameron JD, Wong DTL (2017) Association of epicardial adipose tissue and high-risk plaque characteristics: a systematic review and meta-analysis. J Am Heart Assoc 6(8):e006379. https://doi.org/10.1161/JAHA.117.006379CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Mahabadi AA, Berg MH, Lehmann N, Kälsch H, Bauer M, Kara K, Dragano N, Moebus S, Jöckel KH, Erbel R, Möhlenkamp S (2013) Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall study. J Am Coll Cardiol 61:1388–1395, 13. https://doi.org/10.1016/j.jacc.2012.11.062CrossRefPubMedGoogle Scholar
- 13.Buchner S, Satzl A, Debl K, Hetzenecker A, Luchner A, Husser O, Hamer OW, Poschenrieder F, Fellner C, Zeman F, Riegger GA, Pfeifer M, Arzt M (2014) Impact of sleep-disordered breathing on myocardial salvage and infarct size in patients with acute myocardial infarction. Eur Heart J 35:192–199, 3. https://doi.org/10.1093/eurheartj/eht450CrossRefPubMedGoogle Scholar
- 14.Mayer G, Arzt M, Braumann B, Ficker JH, Fietze I, Frohnhofen H, Galetke W, Maurer JT, Orth M, Penzel T, Pistner H, Randerath W, Rösslein M, Sitter H, Stuck BA (2017) German S3 Guideline Nonrestorative Sleep/Sleep Disorders, chapter “Sleep-Related Breathing Disorders in Adults,” short version: German Sleep Society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, DGSM). Somnologie (Berl) 21:290–301, 4. https://doi.org/10.1007/s11818-017-0136-2CrossRefGoogle Scholar
- 17.Flüchter S, Haghi D, Dinter D, Heberlein W, Kühl HP, Neff W, Sueselbeck T, Borggrefe M, Papavassiliu T (2007) Volumetric assessment of epicardial adipose tissue with cardiovascular magnetic resonance imaging. Obesity (Silver Spring) 15:870–878, 4. https://doi.org/10.1038/oby.2007.591CrossRefGoogle Scholar
- 18.Nelson AJ, Worthley MI, Psaltis PJ, Carbone A, Dundon BK, Duncan RF, Piantadosi C, Lau DH, Sanders P, Wittert GA, Worthley SG (2009) Validation of cardiovascular magnetic resonance assessment of pericardial adipose tissue volume. J Cardiovasc Magn Reson 11(1):15. https://doi.org/10.1186/1532-429X-11-15CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Karastergiou K, Evans I, Ogston N, Miheisi N, Nair D, Kaski JC, Jahangiri M, Mohamed-Ali V (2010) Epicardial adipokines in obesity and coronary artery disease induce atherogenic changes in monocytes and endothelial cells. Arterioscler Thromb Vasc Biol 30:1340–1346, 7. https://doi.org/10.1161/ATVBAHA.110.204719CrossRefPubMedGoogle Scholar
- 21.Salgado-Somoza A, Teijeira-Fernandez E, Fernandez AL, Gonzalez-Juanatey JR, Eiras S (2010) Proteomic analysis of epicardial and subcutaneous adipose tissue reveals differences in proteins involved in oxidative stress. Am J Physiol Heart Circ Physiol 299:H202–H209, 1. https://doi.org/10.1152/ajpheart.00120.2010CrossRefPubMedGoogle Scholar