title: Effects of the Mueller maneuver on functional mitral regurgitation and implications for obstructive sleep apnea.
abstract: Obstructive sleep apnea is prevalent and adversely affects cardiovascular health. However, little is known of the acute effects of an obstructive apnea on cardiovascular physiology. We hypothesized that pre-existing functional mitral regurgitation (MR) would worsen during performance of a Mueller maneuver (MM) used to simulate an obstructive apnea; 15 subjects with an ejection fraction ≤35% and pre-existing functional MR were studied with Doppler echocardiography. The radius of the proximal flow convergence was used as a measure of mitral regurgitant flow. Measurements were made at baseline, during the MM, and post-MM. Areas of all 4 chambers were also measured at these time points, both in systole and diastole. Mean flow convergence radius for the group decreased significantly during the transition from the late-MM to post-MM (0.65 → 0.57 mm, p = 0.001), implying increased MR during the MM. In addition, in 3 subjects, duration of MR increased during the MM. Right atrial (RA) areas, both systolic and diastolic, increased during the maneuver, whereas RA fractional area change decreased, indicating reduced RA emptying. Left ventricular emptying decreased early in the maneuver, probably because of the increased afterload burden, and then recovered. In conclusion, high negative intrathoracic pressure produces changes that, repeated hundreds of times per night in patients with obstructive sleep apnea, have the potential to worsen heart failure and predispose affected subjects to atrial fibrillation.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania. Electronic address: pressmang@einstein.edu.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marek
authors.initials: M
authors.lastname: Orban
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Pavel
authors.initials: P
authors.lastname: Leinveber
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Kunal
authors.initials: K
authors.lastname: Parekh
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Manmeet
authors.initials: M
authors.lastname: Singh
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kara
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000150:complications*
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