Abstract 10761: Obesity and Sleep Apnea are Independently Associated With Adverse Left Ventricular Remodeling and Clinical Outcome in Patients With Atrial Fibrillation and Preserved Ventricular Function
Background: The role of obesity-related illnesses independent of body mass index (BMI) is an active area of investigation. We hypothesized that sleep apnea (SA), a risk factor for heart failure (HF), would have a BMI-independent association with adverse left ventricular (LV) remodeling and clinical outcomes in patients with atrial fibrillation (AF) and preserved LV function.
Methods & Results: From 720 consecutive patients with AF, 403 patients without myocardial disease (preserved LV function, no late gadolinium enhancement) were identified and followed for 3.3±1.5 years. The primary outcome was a combination of all-cause mortality/HF hospitalization. LV mass and LV mass-to-volume ratio were higher in patients with SA and obesity (P<0.0001 for all). BMI (β per log=0.47, P<0.0001) and SA (β=0.05, P=0.045) were independently associated with LV mass index. Patients with treated SA had a lower LV mass index (but not LV mass-to-volume ratio) compared to untreated (P=0.002). In a best-overall multivariable model. SA therapy (β=-0.129, P=0.001) and BMI (β per log=0.373, P=0.0007) had opposing associations with LV mass index. SA (hazard ratio HR=2.94, P=0.0004) and BMI (HR per 1 kg/m2=1.08, P=0.004) were associated with clinical outcome in unadjusted analysis. Only SA was associated with clinical outcome in a best-overall multivariable model (HR=2.14, P=0.02).
Conclusion: SA and obesity are independently associated with adverse LV remodeling and clinical outcomes in patients with preserved LV function, while CPAP therapy is associated with a beneficial effect on LV remodeling. Research investigating SA therapies in patients at high-risk for LV remodeling and HF is warranted.
- © 2013 by American Heart Association, Inc.