Left and right ventricular function alterations in obstructive sleep apnea patients assessed by 2D speckle tracking echocardiography

Introduction

Obstructive sleep apnea (OSA) is related to increased left ventricular (LV) transmural pressure, blood pressure instability and increased pulmonary artery pressure (PAP) leading to left and right ventricular (RV) dysfunction and heart failure. 2D speckle tracking echocardiography (STE) is useful method for subclinical biventricular dysfunction diagnosis, thus might help to earlier treatment for OSA patients.

Purpose

The aim of the study was to evaluate changes of biventricular function and mechanics in patients with OSA.

Methods

We obtained 2D STE from 47 obese patients. 13 patients either did not have OSA, or it was mild (apnea/hypopnea index (AHI) 5–14/hour). OSA group (N=34) consisted of subjects with moderate or severe OSA (AHI ≥15/hour). New indexing for LV myocardial mass and LA volume by height was applied according new guidelines for obese patients. Statistical analyses were performed using the SPSS 27.0 software. The value of p<0.05 was considered as statistically significant.

Results

BMI did not differ between groups (p=0.108). Control group patients were younger, had higher female ratio, meanwhile arterial hypertension was more prevalent in OSA group (26 (76.5%) vs. 5 (38.5%), p=0.014). New indexing by height for left ventricular myocardial mass revealed higher LV MMi in OSA patients (p=0.007), and higher prevalence of LV diastolic dysfunction (p=0.023) was found in this group of patients. Moreover, LA reservoir function was significantly lower in OSA group compared to controls p<0.001. LV ejection fraction and conventional RV function parameters (s', fractional area change (FAC)) did not differ between groups, however LV and RV global longitudinal strain was reduced in OSA patients (p=0.035 and p=0.026, respectively). OSA patients had significantly higher RA diameter, and mean PAP (p=0.043 and p=0.037, respectively) (Table 1).

Conclusions

Moderate or severe obstructive sleep apnea is related to reduced biventricular longitudinal strain, more prevalent LV diastolic dysfunction and lower LA reservoir function. New indexing for LV myocardial mass by height helps to identify myocardial structural changes in obese patients with OSA.

Funding Acknowledgement

Type of funding sources: None.

Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort

The World Health Organization (WHO) recommends countries introduce new anti-TB drugs in the treatment of multidrug-resistant tuberculosis. The aim of the study is to prospectively evaluate the effectiveness of bedaquiline (and/or delamanid)- containing regimens in a large cohort of consecutive TB patients treated globally. This observational, prospective study is based on data collected and provided by Global Tuberculosis Network (GTN) centres and analysed twice a year. All consecutive patients (including children/adolescents) treated with bedaquiline and/or delamanid were enrolled, and managed according to WHO and national guidelines. Overall, 52 centres from 29 countries/regions in all continents reported 883 patients as of January 31st 2021, 24/29 countries/regions providing data on 100% of their consecutive patients (10-80% in the remaining 5 countries). The drug-resistance pattern of the patients was severe (>30% with extensively drug-resistant -TB; median number of resistant drugs 5 (3-7) in the overall cohort and 6 (4-8) among patients with a final outcome). For the patients with a final outcome (477/883, 54.0%) the median (IQR) number of months of anti-TB treatment was 18 (13-23) (in days 553 (385-678)). The proportion of patients achieving sputum smear and culture conversion ranged from 93.4% and 92.8% respectively (whole cohort) to 89.3% and 88.8% respectively (patients with a final outcome), a median (IQR) time to sputum smear and culture conversion of 58 (30-90) days for the whole cohort and 60 (30-100) for patients with a final outcome and, respectively, of 55 (30-90) and 60 (30-90) days for culture conversion. Of 383 patients treated with bedaquiline but not delamanid, 284 (74.2%) achieved treatment success, while 25 (6.5%) died, 11 (2.9%) failed and 63 (16.5%) were lost to follow-up.

Validating the Lithuanian version of the STOP-BANG questionnaire for diagnosing obstructive sleep apnea

BACKGROUND

The aim of this study was to prepare and validate the Lithuanian version of the STOP-BANG questionnaire and evaluate its correlation with polysomnography results.

METHODS

In this study, we included patients ≥ 18 years of age who underwent overnight polysomnography between January 1 in 2018 and January 1 in 2019. All patients completed the STOP-BANG questionnaire before polysomnography. To assess the adequacy of the questionnaire, we used contingency tables and areas under the receiver operating characteristic curve.

RESULTS

The study included 236 patients. The mean age of the patients was 55.2 ± 11.5 years and 159 (68%) were men. The mean apnea-hypopnea index for the entire study group was 33.8 ± 28.4, and the mean STOP-BANG score was 5.4 ± 1.6 points. Moderate (0.3-0.7, p < 0.05) correlations were found between the STOP-BANG questionnaire scores and all measured objective anthropometric and polysomnography parameters. The questionnaire's Cronbach's alpha score was 0.408. Based on the analysis of the ROC curves, the cut-off STOP-BANG score of 3 points showed a sensitivity of 87% and a specificity of 50% (AUC = 0.717) for the identification of any OSA. The positive predictive value (PPV) for an identification of any OSA at a cut-off point of 3 was 96%, and the negative predictive value (NPV) was 26%.

CONCLUSIONS

The linguistic and cultural adaptation of the Lithuanian version of the STOP-BANG questionnaire was carried out in accordance with international recommendations. The Lithuanian version of the STOP-BANG questionnaire is characterized by high sensitivity and average specificity in diagnosing OSA.

P1450 Pulmonary artery sarcoma mimicking as pulmonary thromboembolism for a young man: the role of multimodality imaging for diagnosis

Conclusions

Pulmonary artery sarcoma (PAS) frequently can be misdiagnosed as thromboembolism. Multimodality imaging should be considered pulmonary artery filling defects persist despite proper anticoagulation therapy for early diagnosis and better survival.

Abstract P1450 Figure 3.