Document Detail


Obesity and sleep apnea are independently associated with adverse left ventricular remodeling and clinical outcome in patients with atrial fibrillation and preserved ventricular function.
MedLine Citation:
PMID:  24655713     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
AIMS: Obesity is associated with the development of atrial fibrillation (AF), and both obesity and AF are independently associated with the development of heart failure with preserved ejection fraction. We tested the hypothesis that sleep apnea (SA) would have a body mass index (BMI) independent association with adverse left ventricular (LV) remodeling and clinical outcomes in patients with AF and preserved LV function.
METHODS AND RESULTS: From 720 consecutive patients with AF, 403 patients without myocardial disease (preserved LV function) were identified and followed up for 3.3 ± 1.5 years. The primary outcome was a combination of all-cause mortality/heart failure hospitalization. Left ventricular mass and LV mass-to-volume ratio were higher in patients with SA and obesity (P < .0001 for all). Body mass index (β per log = .47; P < .0001) and SA (β = .05; P = .045) were independently associated with LV mass index. Patients with treated SA had a lower LV mass index (but not LV mass-to-volume ratio) compared with untreated (P = .002). In a best overall multivariable model, SA therapy (β = -.129; P = .001) and BMI (β per log = .373; P = .0007) had opposing associations with LV mass index. Sleep apnea (hazard ratio [HR] = 2.94; P = .0004) and BMI (HR per 1 kg/m(2) = 1.08; P = .004) were associated with clinical outcome in unadjusted analysis. Only SA was associated with clinical outcome in a best overall multivariable model (HR = 2.14; P = .02).
CONCLUSION: Sleep apnea and obesity are independently associated with adverse LV remodeling and clinical outcomes in patients with preserved LV function, whereas continuous positive airway pressure therapy is associated with a beneficial effect on LV remodeling. Research investigating SA therapies in patients at high risk for LV remodeling and heart failure is warranted.
Authors:
Ravi V Shah; Siddique A Abbasi; Bobak Heydari; Hoshang Farhad; John A Dodson; Jessie P Bakker; Roy M John; Aristidis Veves; Atul Malhotra; Ron Blankstein; Michael Jerosch-Herold; Raymond Y Kwong; Tomas G Neilan
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Publication Detail:
Type:  Journal Article     Date:  2014-01-15
Journal Detail:
Title:  American heart journal     Volume:  167     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-03-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  620-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2014 Mosby, Inc. All rights reserved.
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