Abnormal biventricular myocardial blood flow (RV/LV rest MBF ≥ 0.5 and LV MFR < 1.4) increased the risk of incident heart failure or death (HR 2.7 and 3.0), which was attenuated by regular PAP use.
Cohort (n=262)
Do abnormal biventricular myocardial blood flow metrics predict incident heart failure or death in patients with sleep-disordered breathing, and does regular PAP use attenuate this risk?
Abnormal biventricular myocardial blood flow metrics on PET imaging predict incident heart failure or death in patients with sleep-disordered breathing, a risk that may be attenuated by regular PAP therapy.
Effect estimate: HR 2.7 and 3.0
Abstract Background Obstructive sleep apnea (OSA) increases the risk of developing heart failure (HF). Abnormal left ventricular (LV) myocardial blood flow (MBF) and myocardial flow reserve (MFR) are implicated in the development of HF and is prevalent in people with OSA. Increased ratio of right-to-left ventricular MBF at rest (RV/LV rest MBF) predicted all-cause mortality in patients with cardiac amyloidosis. However, it is unknown if LV and RV MBF / MFR predict HF-related outcomes among people with OSA and if positive airway pressure (PAP) therapy attenuates this risk. Methods We analyzed 82Rb cardiac positron emission tomographic (PET) myocardial perfusion images from individuals who also had sleep tests for symptoms of sleep-disordered breathing (SDB) between June 2015 and December 2019. Rest and stress RV and LV MBF were obtained using FlowQuant software (version 3.0, Ottawa Ca). The primary outcome was incident HF, defined as the first hospital admission for HF, or all-cause death. The follow-up period was 7.5 years or 1,375 person-years. We defined regular PAP use as ≥ 70% use for ≥ 4 times a week on a device interrogation that was conducted ≥ 1 year after the patient commenced PAP. Results After excluding those with a HF diagnosis before the cardiac PET, 262 individuals were included in the analyses. The median age and BMI were 60 years and 39.4 kg/m2; 58% of the participants were female. Hypertension was present in 83%, 66% had hyperlipidemia, and 42% had diabetes. In fully adjusted analyses, those with RV/LV rest MBF ≥ 0.5 and LV MFR 1.4 were nearly 3 times more likely to develop HF or die (HR 2.7 and 3.0, respectively). RV/LV rest MBF ≥ 0.5 remained a significant predictor of HF or death among those with normal LV MFR (2.0) and those with non-severe OSA (AHI / REI 30/hr.). Regular PAP use among individuals with OSA (n = 240) attenuated the risk of the primary outcome. See the Figure for details. RV/LV rest MBF ≥ 0.5 was associated with abnormal diastology, increased LV mass and elevated RV systolic pressure on echocardiogram. Conclusion In this population with SDB, LV and RV MBF metrics identified individuals at increased risk of heart failure or death. These metrics were predictive even in subgroups traditionally thought to be at lower cardiac risk including those with normal LV MFR and non-severe OSA. Among those with OSA, regular PAP use attenuated this risk. This abstract is funded by: NIH
Aneni et al. (Fri,) conducted a cohort in Sleep-disordered breathing (n=262). Abnormal biventricular myocardial blood flow (RV/LV rest MBF ≥ 0.5 and LV MFR < 1.4) vs. Normal myocardial blood flow metrics was evaluated on Incident HF (first hospital admission for HF) or all-cause death (HR 2.7 and 3.0). Abnormal biventricular myocardial blood flow (RV/LV rest MBF ≥ 0.5 and LV MFR < 1.4) increased the risk of incident heart failure or death (HR 2.7 and 3.0), which was attenuated by regular PAP use.