title: Obesity and sleep apnea are independently associated with adverse left ventricular remodeling and clinical outcome in patients with atrial fibrillation and preserved ventricular function.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Bobak
authors.initials: B
authors.lastname: Heydari
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Hoshang
authors.initials: H
authors.lastname: Farhad
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jessie P
authors.initials: JP
authors.lastname: Bakker
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Aristidis
authors.initials: A
authors.lastname: Veves
authors.affiliation: Pulmonary and Critical Care Division, University of California San Diego, La Jolla, CA.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
authors.affiliation: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA. Electronic address: tneilan@partners.org.
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Neilan
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*