title: Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study.
abstract: BACKGROUND
  In patients with obstructive sleep apnea syndrome (OSAS), repetitive hypoxia due to sleep-induced apnea adversely affects the interaction between myocardial oxygen demand and supply, resulting in the development of subclinical cardiac dysfunction. The purpose of the study was to analyze the different involvement of left and right heart myocardial function in patients with OSAS treated with noninvasive ventilation (NIV).
  
  
  METHODS
  Conventional Doppler echocardiography, Doppler myocardial imaging (DMI), and two-dimensional speckle tracking echocardiography (2DSTE) of left (LV) and right ventricular (RV) longitudinal and right atrial (RA) deformation were performed in 55 patients with OSAS undergoing NIV (M/F 38/17; mean age 67.8 ± 11.2 years). LV and RV global longitudinal strain (GLS) was calculated by averaging local strain along the entire right and left ventricle, before and during NIV, and after 6 months of nocturnal NIV therapy.
  
  
  RESULTS
  LV morphology was comparable before and during NIV, whereas LV ejection fraction and LV DMI early diastolic peak velocity were significantly improved in patients with OSAS during NIV, as was LV regional peak myocardial strain (P < 0.001). RV diameters were slightly increased in patients with OSAS during ventilation, whereas pulmonary artery systolic pressure (PASP), RV GLS, and regional peak myocardial RV strain were significantly reduced during ventilation (P < 0.0001). RA transverse diameters and RA area were also slightly increased during NIV, whereas RA lateral wall strain was reduced (P < 0.001). Acute RV myocardial impairment completely reversed at follow-up, with a decrease in PASP and subsequent increase in both RV and RA myocardial performance.
  
  
  CONCLUSIONS
  Conventional 2DSTE is a useful tool for assessing left and right heart morphology and myocardial deformation in patients with OSAS and for monitoring both acute and chronic effects of NIV.
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Martone
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Liccardo
authors.affiliation: Division of Pneumology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Mazza
authors.affiliation: Division of Pneumology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Annunziata
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Enza
authors.initials: E
authors.lastname: Di Palma
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Conte
authors.affiliation: Institute of Biostructure and Bioimaging (IBB) of the Italian National Research Council, Naples, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Sirignano
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.affiliation: Division of Cardiology, Evangelic Hospital Villa Betania, Naples, Italy.
authors.forename: Nicolino
authors.initials: N
authors.lastname: Esposito
authors.affiliation: Division of Pneumology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fiorentino
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.affiliation: Department of Cardiology and Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D013318:Stroke Volume; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: Doppler echocardiography; noninvasive ventilation; obstructive sleep apnea syndrome; pulmonary arterial pressure; right ventricle; two-dimensional speckle tracking strain