title: Impact of sleep-disordered breathing on myocardial salvage and infarct size in patients with acute myocardial infarction.
abstract: OBJECTIVE
  Sleep-disordered breathing (SDB) may be a risk factor for expansion of infarct size early after acute myocardial infarction (MI) by exposing the heart to repetitive oxygen desaturations and increased cardiac afterload. The objective of this study was to assess the impact of SDB on myocardial salvage and infarct size within 3 months after acute MI.
  
  
  RESULTS
  Patients with acute MI and percutaneous coronary intervention were enrolled in this prospective observational study. All patients underwent cardiovascular magnetic resonance (CMR) to define salvaged myocardium and infarct size within three to five days and at 3 months after acute MI. Patients were stratified according to apnoea-hypopnoea index (AHI) assessed by polysomnography at baseline into those with (AHI ≥ 15/h) and without (AHI < 15/h) SDB. Of the 56 patients included, 29 (52%) had SDB. The area at risk between both groups was similar (40 ± 12% vs. 40 ± 14%, P = 0.925). Patients with SDB had significantly less salvaged myocardium (myocardial salvage index 52% vs. 77%, P < 0.001), smaller reduction in infarct size (0.3% vs. 6.5%, P < 0.001) within 3 months after acute MI, a larger final infarct size (23% vs. 12%, P < 0.001), and a lower final left ventricular ejection fraction (48% vs. 54%, P = 0.023). In a multivariate analysis, including established risk factors for large MI, AHI was independently associated with less myocardial salvage and a larger infarct size 3 months after acute MI.
  
  
  CONCLUSIONS
  Sleep-disordered breathing was associated with less myocardial salvage and a smaller reduction in infarct size. These findings suggest a contribution of SDB to impaired healing of MI.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Buchner
authors.forename: Anna
authors.initials: A
authors.lastname: Satzl
authors.forename: Kurt
authors.initials: K
authors.lastname: Debl
authors.forename: Andrea
authors.initials: A
authors.lastname: Hetzenecker
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Okka W
authors.initials: OW
authors.lastname: Hamer
authors.forename: Florian
authors.initials: F
authors.lastname: Poschenrieder
authors.forename: Claudia
authors.initials: C
authors.lastname: Fellner
authors.forename: Florian
authors.initials: F
authors.lastname: Zeman
authors.forename: Günter A J
authors.initials: GA
authors.lastname: Riegger
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeifer
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D016879:Salvage Therapy; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000473:pathology*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000473:pathology; D055815:Young Adult
keywords: Heart failure; Magnetic resonance imaging; Myocardial infarction; Sleep apnoea