title: Evaluation of right ventricular remodeling using cardiac magnetic resonance imaging in co-existent chronic obstructive pulmonary disease and obstructive sleep apnea.
abstract: Untreated chronic obstructive pulmonary disease (COPD) co-existing with obstructive sleep apnea (OSA), also known as overlap syndrome, has higher cardiovascular mortality than COPD alone but its underlying mechanism remains unclear. We hypothesize that the presence of overlap syndrome is associated with more extensive right ventricular (RV) remodeling compared to patients with COPD alone. Adult COPD patients (GOLD stage 2 or higher) with at least 10 pack-years of smoking history were included. Overnight laboratory-based polysomnography was performed to test for OSA. Subjects with an apnea-hypopnea index (AHI) >10/h were classified as having overlap syndrome (n = 7), else classified as having COPD-only (n = 11). A cardiac MRI was performed to assess right and left cardiac chambers sizes, ventricular masses, and cine function. RV mass index (RVMI) was markedly higher in the overlap group than the COPD-only group (19 ± 6 versus 11 ± 6; p = 0.02). Overlap syndrome subjects had a reduced RV remodeling index (defined as the ratio between RVMI and RV end-diastolic volume index) compared to the COPD-only group (0.27 ± 0.06 versus 0.18 ± 0.08; p = 0.02). In the overlap syndrome subjects, the extent of RV remodeling was associated with severity of oxygen desaturation (R(2) = 0.65, p = 0.03). Our pilot results suggest that untreated overlap syndrome may cause more extensive RV remodeling than COPD alone.
authors.affiliation: Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. bhavn008@gmail.com
authors.forename: Bhavneesh
authors.initials: B
authors.lastname: Sharma
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
authors.forename: Damien
authors.initials: D
authors.lastname: Mandry
authors.forename: Robert L
authors.initials: RL
authors.lastname: Owens
authors.forename: David
authors.initials: D
authors.lastname: McSharry
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Bakker
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D000368:Aged; D005080:Exercise Test; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D017286:Polysomnography; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications*; D018709:Statistics, Nonparametric; D020257:Ventricular Remodeling
chemical_list: D010100:Oxygen