Obstructive apneas produce high negative intrathoracic pressure which imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no OSA (AHI < 15) and mod/severe OSA (AHI ≥ 15). Mitral valve tenting height and area, left ventricular (LV) long and short axis, and LV end-diastolic volume (LVEDV), were measured along with tissue Doppler parameters. Comparisons of measurements at baseline and follow up between and within groups were obtained; correlations between absolute changes (deltas) in echocardiographic parameters were also performed. After a mean follow up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 cm to 1.28 ± 0.17 cm, p=0.001) in mod/severe OSA as did tenting area (2.30 ± 0.41 cm2 to 2.66 ± 0.60 cm2, p=0.0002); delta tenting height correlated with delta LVEDV (rho 0.43, p=0.01) and delta tenting area (rho 0.35, p=0.04). In mild/no OSA patients there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 cm2 to 2.31 ± 0.43 cm2, p=0.05). Septal E’ decreased (8.04 ± 2.49 cm/sec to 7.10 ± 1.83 cm/sec, p=0.005) in mod/severe OSA subjects, but not in the mild/no OSA group. In conclusion, in patients with mod/severe OSA, mitral valve tenting height and tenting area increase significantly over time. This appears to be related, at least in part, to changes in LV geometry.
Recommended CitationPressman, Gregg S.; Figueredo, Vincent M.; Romero-Corral, Abel; Murali, Ganesan; and Kotler, Morris N, "Effect of obstructive sleep apnea on mitral valve tenting." (2012). Division of Cardiology Faculty Papers. Paper 20.