Abstract 3263: Right Heart Findings on Supine Bicycle Stress Echocardiography are Highly Predictive of Severe Sleep Apnea in Women Presenting with Chest Pain and Shortness of Breath
Background: Chest pain and shortness of breath may be multifactorial, especially in women, and not always indicative of ischemic heart disease. Sleep apnea may contribute to mortality and morbidity in ischemic heart and cerebral vascular patients. Supine bicycle echocardiography is an effective tool to evaluate right heart function at rest and with stress.
Objective: To determine if right heart abnormalities driving supine bicycle stress echocardiography are predictive of hemodynamic significant sleep apnea.
Methods: 638 consecutive women presenting with chest pain and/or shortness of breath underwent multistage supine bicycle stress echocardiography/Doppler imaging for left ventricular wall motion, ejection fraction (EF), right ventricular (RV) size and function, tricuspid (TR) and mitral (MR) regurgitation, and systolic pressure. Data was also collected on those who underwent sleep studies. ROC analysis was used to evaluate predictive value for severe sleep apnea (RDI ≥ 30).
Results: Mean age was 63 ± 13 years, mean BMI 30 ± 7, and 80% post-menopausal. Mean EF was 62 ± 12%. Supine bicycle stress echocardiography/Doppler at peak exercise revealed moderate/severe RV enlargement 26%, RV hypokinesis 26%, and moderate/severe TR 40%. Mean values for exercise tolerance, peak heart rate, and peak systolic blood pressure were 4.3 ± 1.7 METs, 131 ± 23 bpm, and 183 ± 26 mmHg, respectively. Sleep study data was available for 88 women, of whom 45% had an RDI ≥ 30. 83% of sleep study subjects exhibited a combination of moderate/severe TR, moderate/severe RV dilatation, or moderate/severe hypokinetic RV function. The best predictor of severe sleep apnea was RV size (C = 0.705) at peak exercise. RV function (C = 0.640) and TR volume (C = 0.603) at peak exercise were moderate predictors. Epworth score (10.4 ± 4.0; C = NA) or pulmonary pressure (77.5 ± 14.7 mmHg; C = 0.525) alone were only fair predictors. A model containing RV function, RV size, TR, and EF at peak exercise (C = 0.730) further improved prediction of identification of those with severe sleep apnea.
Conclusion: Sleep apnea can present with cardiopulmonary symptoms in advanced stages. Right heart abnormalities during supine bicycle stress echocardiography warrant screening for moderate/severe sleep apnea.