Using speckle-tracking echocardiography to evaluate subclinical left ventricular dysfunction in patients with obstructive sleep apnea syndrome

Effects of 3 months of treatment with empagliflozin on left ventricle global longitudinal strain and myocardial mechano-energetic effiency

PURPOSE

Sodium glucose transporter-2 (SGLT-2) inhibitors are employed in the treatment of cardiovascular diseases such as heart failure and coronary artery disease. In the present study, we aimed to investigate how Empagliflozin in SGLT 2 inhibitors affects cardiac contraction and pump efficiency in patients who have Diabetes Mellitus (DM) without cardiovascular disease.

METHODS

The conventional echocardiographic records and biochemical values ​​of 62 patients who had DM without a history of cardiovascular disease were evaluated before using Empagliflozin. The myocardial mechano-energetic (MME) activity and index, and global longitudinal strain (GLS) were also calculated. After 3 months of Empagliflozin use, the tests were repeated and compared with previous data. A p < .05 was considered statistically significant.

RESULTS

Left ventricular GLS and MME efficiency were found to be significantly higher after treatment (-17.71 ± 2.12, -19.15 ± .71; p < .001 and 62.14 ± 18.21, 72.24 ± 26.57; p: .019).

CONCLUSION

An increase was detected in left ventricular longitudinal strain and MME efficiency after using Empagliflozin for 3 months in patients with DM. This result suggests that Empagliflozin improves left ventricular pump efficiency and contraction.

Obstructive sleep apnea is associated with depressed myocardial mechanoenergetics

PURPOSE

To evaluate the association between the myocardial mechanoenergetic efficiency index (MEEi) and the Apnea-Hypopnea Index (AHI) in the initial phase of obstructive sleep apnea (OSA) diagnosis.

METHODS

In this cohort study, we included a total of 382 eligible participants without cardiovascular disease in a tertiary outpatient clinic between January 2013 and January 2015. We recorded demographic, clinical, polysomnographic and echocardiographic variables of the patients. In addition, myocardial mechanoenergetic efficiency (MEE) and MEEi were calculated by an echocardiography-derived validated measurement.

RESULTS

The mean (±SD) age of the participants was 48.47 ± 12.13, and male/female ratio was 287/95. Comparing with non-OSA, MEEi was significantly lower in OSA patients at all stages (0.35 ± 0.08 vs. 0.42 ± 0.05; p < .001). MEEi was negatively correlated with hypertension (r = -0.518, p < .001), body mass index (r = -0.382, p < .001), AHI (r = -0.656, p < .001), total apne (r = -0.525, p < .001), hypopnea (r = -0.415, p < .001), systolic pulmonary pressure (r = -0.318, p < .001), relative wall thickness (RWT; r = -0.415, p < .001), and positive correlated with left ventricular ejection fraction (r = 0.586, p < .001). According to multiple linear regression analysis AHI (β = -0.625, p < .001), total apnea (β = -0.402, p = .001), hypopnea (β = -0.395, p = .001), LV ejection fraction (β = 0.478, p < .001) and RWT (β = -0.279, p < .001) have an independent relationship with MEEi.

CONCLUSIONS

MEEi was lower in OSA patients. A reduced MEEi may reflect a disturbance in energy use of the myocardium. Consequently, our results may provide insight into the mechanisms leading to structural cardiac diseases in OSA patients.