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Teo YH, Yong CL, Ou YH, Tam WW, Teo YN, Koo CY, Kojodjojo P, Lee CH. Obstructive sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting. J Clin Sleep Med 2024; 20:49-55. [PMID: 38163943 PMCID: PMC10758550 DOI: 10.5664/jcsm.10786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 01/03/2024]
Abstract
STUDY OBJECTIVES In coronary artery bypass grafting (CABG), abnormal cardiac repolarization is associated with adverse cardiovascular events that can be measured via the QTc interval. We investigated the impact of obstructive sleep apnea on the change in repolarization after CABG and the association of change in repolarization with the occurrence of major adverse cardiac and cerebrovascular events. METHODS A total of 1,007 patients from 4 hospitals underwent an overnight sleep study prior to a nonemergent CABG. Electrocardiograms of 954 patients (median age: 62 years; male: 86%; mean follow-up: 2.1 years) were acquired prospectively within 48 hours before CABG (T1) and within 24 hours after CABG (T2). QTc intervals were measured using the BRAVO algorithm by Analyzing Medical Parameters for Solutions LLC. The change in T2 from T1 for QTc (ΔQTc) was derived, and Cox regression was performed. RESULTS Compared with those without, patients who developed major adverse cardiac and cerebrovascular events (n = 115) were older and had (1) a higher prevalence of smoking, hypertension, diabetes mellitus, and chronic kidney disease; (2) a higher apnea-hypopnea index and oxygen desaturation index; and (3) a smaller ΔQTc. Cox regression analysis demonstrated a smaller ΔQTc to be an independent risk factor for major adverse cardiac and cerebrovascular events (hazard ratio: 0.997; P = .032). In the multivariable regression model, a higher oxygen desaturation index was independently associated with a smaller ΔQTc (correlation coefficient: -0.58; P < .001). CONCLUSIONS A higher preoperative oxygen desaturation index was an independent predictor of a smaller ΔQTc. ΔQTc within 24 hours after CABG could be a novel predictor of occurrence of major adverse cardiac and cerebrovascular events at medium-term follow-up. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Undiagnosed Sleep Apnea and Bypass OperaTion (SABOT); URL: https://classic.clinicaltrials.gov/ct2/show/NCT02701504; Identifier: NCT02701504. CITATION Teo YH, Yong CL, Ou YH, et al. Obstructive sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting. J Clin Sleep Med. 2024;20(1):49-55.
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Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cai Ling Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Hui Ou
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wilson W. Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Yao Neng Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Asian Heart and Vascular Centre (AHVC), Singapore
- Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | | | - Chi-Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Cardiovascular Research Institute, National University of Singapore, Singapore
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Otto CM. Heartbeat: therapeutic targets for prevention of calcific aortic valve stenosis. Heart 2021; 106:1369-1371. [PMID: 32847929 DOI: 10.1136/heartjnl-2020-318014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98195, USA
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Otto CM, Bermejo J. Instantaneous pressure-flow relationships in aortic stenosis. Heart 2020; 106:1778. [PMID: 32907826 DOI: 10.1136/heartjnl-2020-317904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Javier Bermejo
- Cardiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Bing R, Gu H, Newby DE, Chowienczyk P, Dweck MR. The Authors' reply: instantaneous pressure-flow relationships in aortic stenosis. Heart 2020; 106:1778-1779. [PMID: 32907825 DOI: 10.1136/heartjnl-2020-317935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Haotian Gu
- BHF Centre of Research Excellence, King's College London, London, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Phil Chowienczyk
- BHF Centre of Research Excellence, King's College London, London, UK
| | - Marc Richard Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98115, USA
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Otto CM. Heartbeat: weather, air pollution and cardiac arrest. Heart 2020; 106:1193-1195. [PMID: 32719148 DOI: 10.1136/heartjnl-2020-317777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98115, USA
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Singh AD, Mian A, Devasenapathy N, Guyatt G, Karthikeyan G. Percutaneous mitral commissurotomy versus surgical commissurotomy for rheumatic mitral stenosis: a systematic review and meta-analysis of randomised controlled trials. Heart 2020; 106:1094-1101. [PMID: 31974210 DOI: 10.1136/heartjnl-2019-315906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 11/03/2022] Open
Abstract
AIM Patients with severe mitral stenosis (MS) and their clinicians typically choose percutaneous transvenous mitral commissurotomy (PTMC) over surgical commissurotomy (SC). However, the durability of PTMC relative to SC is uncertain. We compared the efficacy, safety and durability of PTMC with SC for the treatment of MS. METHODS We searched EMBASE, MEDLINE and WHO ICTRP registers for randomised controlled trials (RCTs) comparing PTMC, and open and/or closed mitral commissurotomy. The principal outcomes were rate of re-intervention and symptomatic improvement as inferred from the surrogate measures of immediate postprocedural mitral valve area (MVA), MVA at ≥6 month follow-up, incidence of mitral regurgitation (MR) and restenosis. We calculated weighted mean differences (WMD) for continuous outcomes, relative risks (RR) for binary outcomes and pooled outcomes using random-effects models and assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Seven RCTs with 553 patients proved eligible. Pooled estimates showed no convincing difference in the risk of restenosis or re-intervention (15/100 fewer with PTMC, 95% CI (-20 to +8); quality of evidence: moderate) or in symptoms as inferred from immediate MVA (WMD 0.15, 95% CI (-0.18 to 0.48): very low), from the incidence of postprocedural severe MR (3/100 more with PTMC, 95% CI (-1 to +10): moderate) or from MVA at 30 months. CONCLUSION Until data demonstrating convincing superiority of SC over PTMC become available, our results support the current practice of recommending PTMC to young patients with MS and favourable valve morphology, as it is associated with lower peri-procedural morbidity. PROSPERO REGISTRATION NUMBER PROSPERO 2017 (CRD42017079512).
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Affiliation(s)
| | - Agrima Mian
- Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Gordon Guyatt
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- Saverio Stranges
- Department of Epidemiology and Biostatistics and Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada .,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Andrea Takeda
- Institute of Health Informatics, University College London, London, UK
| | - Nicole Martin
- Institute of Health Informatics, University College London, London, UK
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA 98195, USA
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11
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Otto CM. Heartbeat: pacer risk in patients with right bundle branch block. Heart 2019; 105:1131-1133. [PMID: 31308094 DOI: 10.1136/heartjnl-2019-315623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Otto CM. Heartbeat: Balance of safety and efficacy of antihypertensive treatment in elderly patients. Heart 2019; 105:1049-1050. [PMID: 31243112 DOI: 10.1136/heartjnl-2019-315459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/04/2022] Open
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Affiliation(s)
| | - Christina Stewart
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas W Weir
- Department of Medical Physics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El-Wegoud M, Nabhan AF. Cochrane corner: is it better to access the coronary circulation via the radial or the femoral artery? Heart 2019; 105:668-670. [PMID: 30700521 DOI: 10.1136/heartjnl-2018-313852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ahmed A Kolkailah
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Rabah S Alreshq
- Department of Medicine, Albany Medical Center, Albany, New York, USA
| | - Ahmed M Muhammed
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed E Zahran
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ashraf F Nabhan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Affiliation(s)
- Alfonso Tafur
- Department of Medicine, Vascular Medicine, Northshore University Health System. University of Chicago, Chicago, Illinois, USA.,Department of Medicine, St Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - James Douketis
- Department of Medicine, St Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
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Abstract
Most cardiovascular disease (CVD) occurs in patients over the age of 60. However, most evidence-based current cardiovascular guidelines lack evidence in an older population, due to the under-representation of older patients in randomised trials. Blood pressure rises with age due to increasing arterial stiffness, and stricter control results in improved outcomes. Myocardial ischaemia is also more common with increasing age, due to a combination of coronary artery disease and myocardial changes. However, despite higher rates of adverse outcomes, older patients are offered guideline-based therapy less frequently. Frailty is an independent predictor of mortality in adults over the age of 60, yet remains poorly assessed; slow gait speed is a key marker for the development of frailty and for adverse outcomes following intervention. Few trials have assessed frailty independent of age; however, there is evidence that non-frail older patients derive significant benefit from therapy, highlighting the urgent need to include frailty as a measure in clinical trials of treatment in CVD.In this review, the authors appraise the literature in regard to the cardiovascular changes with ageing, specifically in relation to the systemic and coronary circulation and with a particular emphasis on frailty and its implication in the evaluation and treatment of CVD.
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Affiliation(s)
- Shane Nanayakkara
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David M Kaye
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Conway A, Ersotelos S, Sutherland J, Duff J. Forced air warming during sedation in the cardiac catheterisation laboratory: a randomised controlled trial. Heart 2017; 104:685-690. [PMID: 28988209 PMCID: PMC5890638 DOI: 10.1136/heartjnl-2017-312191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Forced air warming (FAW) during general anaesthesia is a safe and effective intervention used to reduce hypothermia. The objective of this study was to determine if FAW reduces hypothermia when used for procedures performed with sedation in the cardiac catheterisation laboratory. METHODS A parallel-group randomised controlled trial was conducted. Adults receiving sedation in a cardiac catheterisation laboratory at two sites were randomised to receive FAW or usual care, which involved passive warming with heated cotton blankets. Hypothermia, defined as a temperature less than 36°C measured with a sublingual digital thermometer after procedures, was the primary outcome. Other outcomes were postprocedure temperature, shivering, thermal comfort and major complications. RESULTS A total of 140 participants were randomised. Fewer participants who received FAW were hypothermic (39/70, 56% vs 48/69, 70%, difference 14%; adjusted RR 0.75, 95% CI=0.60 to 0.94), and body temperature was 0.3°C higher (95% CI=0.1 to 0.5, p=0.004). FAW increased thermal comfort (63/70, 90% vs51/69, 74% difference 16%, RR 1.21, 95% CI=1.04 to 1.42). The incidence of shivering was similar (3/69, 4% vs 0/71 0%, difference 4%, 95% CI=-1.1 to 9.8). One patient in the control group required reintervention for bleeding. No other major complications occurred. CONCLUSION FAW reduced hypothermia and improved thermal comfort. The difference in temperature between groups was modest and less than that observed in previous studies where use of FAW decreased risk of surgical complications. Therefore, it should not be considered clinically significant. TRIAL REGISTRATION NUMBER ACTRN12616000013460.
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Affiliation(s)
- Aaron Conway
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Cardiac Catheter Theatres, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Suzanna Ersotelos
- Cardiac Catheter Laboratory, St Vincent's Private Hospital, Sydney, Australia
| | - Joanna Sutherland
- Department of Anaesthesia, Coffs Harbour Health Campus, Coffs Harbour, Australia.,Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - Jed Duff
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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