Assessment of coronary flow reserve using transthoracic echocardiography in patients with obstructive sleep apnea hypopnea syndrome

doi:10.3877/cma.j.issn.1672-6448.2015.06.006

Abstract

Abstract:

Objective

To estimate the value of transthoracic coronary flow Doppler imaging to detect coronary flow reserve (CFR) changes in patient with obstructive sleep apnea syndrome (OSA).

Methods

Fifty patients with OSA who hospitalized or were outpatient in Aerospace 731 Hospital during the period of 2010 March to 2013 December were enrolled in this study and were divided into three groups according to apnea hypopnea index (AHI). Eighteen cases of patients which AHI was greater than 5 and less than 20 were defined as mild group, 16 cases of patients which AHI was more than 20 and less than 40 were defined as middle group, 16 cases of patients which AHI was greater than 40 were defined as severe group. The diastolic peak velocity (PDV) and mean flow velocity (MDV) of the distance segment of left anterior descending coronary (LAD) were measured by transthoracic echocardiography at rest and after intravenous infusion of adenosine triphosphate (ATP). Meanwhile, CFR was calculated. Forty healthy persons were chosen as control group. The t test was used to compare the difference of PDV, MDV and CFR between OSA group and healthy controls. The single factor analysis of variance was used to compare the difference of PDV, MDV and CFR in patients with different AHI. SNK - q test was used to compare in different OSA groups. The t test was used to compare the difference of PDV, MDV among OSA group, healthy control and OSA groups with different AHI at rest and after intravenous infusion of ATP.

Results

Coronary flow velocity Doppler signals were successfully obtained in all the groups. PDV [(92.78±7.68) cm/s] and MDV [(85.93±6.98) cm/s] after intravenous infusion of ATP in control group were significant higher than those at rest [(28.09±4.55) cm/s and (21.76±5.09) cm/s] (t=49.687 and 58.259, both P<0.001). PDV [(82.73±6.91)] cm/s) and MDV [(77.39±6.73) cm/s] after intravenous infusion of ATP in OSA group were significant higher than those at rest [(29.93±3.66) cm/s and (22.28±4.15) cm/s] (t=55.381 and 47.700, both P<0.001). There was no statistically significant difference between PDV and MDV at rest in OSA group and control group. The difference of PDV and MDV between OSA group and normal group was statistically significant after intravenous infusion of ATP (t=6.524 and 5.884, both P<0.01). There was no statistically significant difference between OSA groups with different AHI at rest. There were statistically significant difference between OSA groups with different AHI after intravenous infusion of ATP (5≤AHI<20: t=-32.903 and -32.771, both P=0.000; 20≤AHI<40: t=-37.122 and -32.623, both P=0.000; AHI≥40: t=-28.197 and -20.184, both P=0.000). PDV and MDV of patients with AHI≥40 were less than those of patients with 5≤AHI <20 and 20≤AHI<40 and the differences were statistically significant (PDV: q=21.048 and 15.667, both P<0.05; MDV: q=12.958 and 18.182, both P<0.05). However, the differences of PDV and MDV was not statistically significant between patients with 5≤AHI<20 and patients with 20≤AHI<40.The CFRmax and CFRmean in OSA group were lower than those in control group (t=5.310 and 6.430, both P=0.000). There were statistically significant difference for CFRmax and CFRmean in patients with different AHI and the difference decreased with severity of OSA increased. The CFRmax and CFRmean in patients with 5≤AHI<20 were higher than those in patients with 20≤AHI<40 and AHI≥40 (CFRmax: q=2.889 and 4.142, both P<0.05; CFRmean: q=3.080 and 4.204, both P<0.05). There was no statistical significant difference for CFRmax and CFRmean between patients with 20≤AHI<40 and patients with AHI≥40.

Conclusions

In patients with obstructive sleep apnea syndrome, transthoracic coronary flow imaging combined with intravenous infusion of adenosine triphosphate shows impaired in CFR. It means the patients with OSA have a coronary artery microcirculation impairment in early stage. Assessing CFR in the patients with OSA is of important clinical value for the evaluation of treatment effective of medicine and surgery and follow-up.

Key words: Echocardiography, Obstructive sleep apnea syndrome, Coronary flow reserve

Yuping Zhang, Li Zhang, Chunmei Ma, Xiaogang Xiao, Hua Ren, Meiyue Cui. Assessment of coronary flow reserve using transthoracic echocardiography in patients with obstructive sleep apnea hypopnea syndrome[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(06): 438-445.

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Figures/Tables 7

References 17

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组别		例数	年龄（岁，±s）	性别（例，男性/女性）	身高（cm，±s）	体重（kg，±s）	收缩压（mmHg，±s）	舒张压（mmHg，±s）	空腹血糖浓度（mmol/L，±s）	胆固醇浓度（mmol/L，±s）
健康对照组		40	45.2 ± 14.2	35/5	168.9 ± 9.2	64.9 ± 10.2	131 ± 3	75 ± 2	5.14 ± 0.49	3.71 ± 0.55
OSA组		50	42.9 ± 11.9	42/8	168.1 ± 8.1	76.1 ± 11.0	153 ± 9	88 ± 7	5.33 ± 0.52	4.11 ± 0.87
?	检验值	?	t=0.836	χ²=0.220	t=0.438	t=-4.956	t=-13.373	t=-10.995	t=-1.767	t=-2.530
?	P值	?	0.407	0.639	0.663	0.000	0.000	0.000	0.083	0.015
组别		例数	三酰甘油浓度（mmol/L，±s）	低密度脂蛋白浓度（mmol/L，±s）	高密度脂蛋白浓度（mmol/L，±s）	左心室舒张末内径（mm，±s）	左心室射血分数（%，±s）	二尖瓣E/A比值（±s）	二尖瓣E/E′比值（±s）
健康对照组		40	1.25 ± 0.28	1.29 ± 0.33	1.2 ± 0.3	50.8 ± 2.7	72.9 ± 5.0	1.03 ± 0.49	9.12 ± 3.22
OSA组		50	2.19 ± 0.87	2.33 ± 0.49	1.2 ± 0.6	51.3 ± 3.0	75.2 ± 6.5	0.99 ± 0.57	10.79 ± 3.09
?	检验值	?	t=-6.561	t=-11.493	t=0.410	t=-0.814	t=-1.844	t=0.352	t=-2.500
?	P值	?	0.000	0.000	0.683	0.419	0.071	0.726	0.016

组别		例数	年龄（岁，±s）	性别（例，男性/女性）	身高（cm，±s）	体重（kg，±s）	收缩压（mmHg，±s）	舒张压（mmHg，±s）	空腹血糖浓度（mmol/L，±s）	胆固醇浓度（mmol/L，±s）
健康对照组		40	45.2 ± 14.2	35/5	168.9 ± 9.2	64.9 ± 10.2	131 ± 3	75 ± 2	5.14 ± 0.49	3.71 ± 0.55
OSA组		50	42.9 ± 11.9	42/8	168.1 ± 8.1	76.1 ± 11.0	153 ± 9	88 ± 7	5.33 ± 0.52	4.11 ± 0.87
?	检验值	?	t=0.836	χ²=0.220	t=0.438	t=-4.956	t=-13.373	t=-10.995	t=-1.767	t=-2.530
?	P值	?	0.407	0.639	0.663	0.000	0.000	0.000	0.083	0.015
组别		例数	三酰甘油浓度（mmol/L，±s）	低密度脂蛋白浓度（mmol/L，±s）	高密度脂蛋白浓度（mmol/L，±s）	左心室舒张末内径（mm，±s）	左心室射血分数（%，±s）	二尖瓣E/A比值（±s）	二尖瓣E/E′比值（±s）
健康对照组		40	1.25 ± 0.28	1.29 ± 0.33	1.2 ± 0.3	50.8 ± 2.7	72.9 ± 5.0	1.03 ± 0.49	9.12 ± 3.22
OSA组		50	2.19 ± 0.87	2.33 ± 0.49	1.2 ± 0.6	51.3 ± 3.0	75.2 ± 6.5	0.99 ± 0.57	10.79 ± 3.09
?	检验值	?	t=-6.561	t=-11.493	t=0.410	t=-0.814	t=-1.844	t=0.352	t=-2.500
?	P值	?	0.000	0.000	0.683	0.419	0.071	0.726	0.016

组别	例数	年龄（岁）	身高（cm）	体重（kg）	收缩压（mmHg）	舒张压（mmHg）	空腹血糖浓度（mmol/L）	三酰甘油浓度（mmol/L）
5≤AHI<20	18	41.6 ± 11.0	167.3 ± 9.1	67.1 ± 10.0	126 ± 5	79 ± 5	5.71 ± 0.53	1.53 ± 0.82
20≤AHI<40	16	45.2 ± 12.9	164.1 ± 8.8	73.0 ± 10.3	139 ± 8	82 ± 9^c	5.91 ± 0.76	2.73 ± 0.77
AHI≥40	16	43.9 ± 12.0	166.8 ± 8.5	81.8 ± 9.2^a	149 ± 10^b	89 ± 8^d	5.82 ± 0.52	3.59 ± 0.98^e
F值	?	0.398	0.629	9.489	35.632	7.964	0.459	24.714
P值	?	0.673	0.537	0.000	0.000	0.001	0.635	0.000
组别	例数	胆固醇浓度（mmol/L）	低密度脂蛋白浓度（mmol/L）	高密度脂蛋白浓度（mmol/L）	左心室舒张末内径（mm）	左心室射血分数（%）	二尖瓣E/A比值	二尖瓣E/E′比值
5≤AHI<20	18	3.69 ± 0.91	1.83 ± 0.55	1.31 ± 0.44	49.3 ± 3.7	70.9 ± 6.0	1.03 ± 0.77	9.76 ± 2.66
20≤AHI<40	16	4.11 ± 0.99	2.02 ± 0.59	1.11 ± 0.52	50.1 ± 3.7	72.2 ± 6.3	0.89 ± 1.02	12.09 ± 2.71
AHI≥40	16	4.31 ± 1.09	2.67 ± 0.40^f	1.09 ± 0.68	50.9 ± 4.0	75.1 ± 6.5	0.79 ± 0.96	12.46 ± 3.69^g
F值	?	1.732	1.848	0.841	0.749	1.958	0.295	3.998
P值	?	0.188	0.000	0.437	0.478	0.152	0.746	0.025

组别	例数	年龄（岁）	身高（cm）	体重（kg）	收缩压（mmHg）	舒张压（mmHg）	空腹血糖浓度（mmol/L）	三酰甘油浓度（mmol/L）
5≤AHI<20	18	41.6 ± 11.0	167.3 ± 9.1	67.1 ± 10.0	126 ± 5	79 ± 5	5.71 ± 0.53	1.53 ± 0.82
20≤AHI<40	16	45.2 ± 12.9	164.1 ± 8.8	73.0 ± 10.3	139 ± 8	82 ± 9^c	5.91 ± 0.76	2.73 ± 0.77
AHI≥40	16	43.9 ± 12.0	166.8 ± 8.5	81.8 ± 9.2^a	149 ± 10^b	89 ± 8^d	5.82 ± 0.52	3.59 ± 0.98^e
F值	?	0.398	0.629	9.489	35.632	7.964	0.459	24.714
P值	?	0.673	0.537	0.000	0.000	0.001	0.635	0.000
组别	例数	胆固醇浓度（mmol/L）	低密度脂蛋白浓度（mmol/L）	高密度脂蛋白浓度（mmol/L）	左心室舒张末内径（mm）	左心室射血分数（%）	二尖瓣E/A比值	二尖瓣E/E′比值
5≤AHI<20	18	3.69 ± 0.91	1.83 ± 0.55	1.31 ± 0.44	49.3 ± 3.7	70.9 ± 6.0	1.03 ± 0.77	9.76 ± 2.66
20≤AHI<40	16	4.11 ± 0.99	2.02 ± 0.59	1.11 ± 0.52	50.1 ± 3.7	72.2 ± 6.3	0.89 ± 1.02	12.09 ± 2.71
AHI≥40	16	4.31 ± 1.09	2.67 ± 0.40^f	1.09 ± 0.68	50.9 ± 4.0	75.1 ± 6.5	0.79 ± 0.96	12.46 ± 3.69^g
F值	?	1.732	1.848	0.841	0.749	1.958	0.295	3.998
P值	?	0.188	0.000	0.437	0.478	0.152	0.746	0.025

组别	例数	PDV（cm/s）				MDV（cm/s）				心率增加幅度（次/min）	血压下降幅度（mmHg）
组别	例数	静息状态	ATP负荷	t值	P值	静息状态	ATP负荷	t值	P值	心率增加幅度（次/min）	血压下降幅度（mmHg）
健康对照组	40	28.09 ± 4.55	92.78 ± 7.68	49.687	<0.001	21.76 ± 5.09	85.93 ± 6.98	58.259	<0.001	19 ± 6	20 ± 4
OSA组	50	29.93 ± 3.66	82.73 ± 6.91	55.381	<0.001	22.28 ± 4.15	77.39 ± 6.73	47.700	<0.001	18 ± 4	19 ± 3
t值	?	0.971	6.524	?	?	0.534	5.884	?	?	1.367	1.822
P值	?	0.336	0.000	?	?	0.596	0.000	?	?	0.179	0.076

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