Lujza Zikmund Galková

Sleep Apnea Prevalence in Acute Myocardial Infarction - the Sleep Apnea in Post Acute Myocardial Infarction Patients (SAPAMI) Study

BACKGROUND While sleep apnea (SA) might be a modifiable cardiovascular risk factor, recent data suggest that SA is severely underdiagnosed in patients after acute myocardial infarction (MI). There is limited evidence about day-night variation of onset of MI on dependence of having SA. We therefore investigated the prevalence of SA and examined the day-night variation of onset of MI in acute MI patients. METHODS We prospectively studied 782 consecutive patients admitted to the hospital with the diagnosis of acute MI. All subjects underwent sleep evaluations using a portable device after at least 48 h post-admission. Using the apnea-hypopnea index (AHI), groups were defined as patients without SA (<5 events/h), mild SA (5-15 events/h), moderate SA (15-30 events/h), and severe SA (≥ 30 events/h). RESULTS Almost all patients (98%) underwent urgent coronary angiography and 91% of patients underwent primary PCI. Using a threshold of AHI ≥ 5 events/h, SA was present in 65.7% of patients after acute MI. Mild SA was present in 32.6%, moderate in 20.4% and severe in 12.7%. The day-night variation in the onset of MI in all groups of SA patients was similar to that observed in non-SA patients. From 6 AM to 12 PM, the frequency of MI was higher in both SA and non-SA patients, as compared to the interval from 12 AM to 6 AM (all p<0.05). CONCLUSION There is a high prevalence of SA in patients presenting with acute MI. Peak time of MI onset in SA patients was between 6 AM and noon, similar to that in the general population. Whether diagnosis and treatment of SA after MI will significantly improve outcomes in these patients remains to be determined.

Usefulness of exercise tissue doppler echocardiography for prognostic stratification of congestive heart failure patients with left ventricular systolic dysfunction.

AIM Determination of the importance of exercise tissue Doppler echocardiography in prognostic stratification of congestive heart failure patients with systolic dysfunction. METHODS 106 patients with congestive heart failure and LVEF ≤ 45% on optimal pharmacotherapy were included in the study. Results of resting and post-exercise echocardiography, cardiopulmonary exercise test and serum BNP levels were available for all patients. Two patient groups were constituted, based on the prognostic classification. Group I contained 21 patients with poor prognosis (defined by predicted value of pVO2 < 76% together with both VE/VCO2 slope > 32.7 and BNP > 210 pg/mL) and group II with 85 patients who did not meet the criteria. RESULTS The patient groups significantly differed in indexed volume of left atrium, mitral regurgitation severity, rest and post-exercise systolic velocity of mitral annulus and in rest and post-exercise E/Em. Multivariate analysis identified E/Em as the only independent predictor of prognosis. E/Em at rest (post-exercise) ≥ 16.6 (≥ 18.7) defined poor prognosis with sensitivity of 71% (86%) and specificity of 71% (71%). CONCLUSION Our study suggests usefulness of exercise tissue Doppler echocardiography for prognostic stratification of patients with congestive heart failure with possible superiority to resting parameters.