The Evaluation Of Left Cardiac Function Of Congestive Heart Failure With Obslruetive Sleep Apnea-Hypopnea Syndrome In Elderly Patients

Objectives To evaluate the left cardiac function of elderly patients with chronic congestive heart failure(CHF) and obstructive sleep apnea hypopnea syndrome(OSAHS),and the relationship between severity of OSAHS,noctumal hypoxia, hypercapnia and left cardiac function. To observe the influence of OSAHS on left cardiac function of the patients with CHF.Design Cross-sectional study.Setting Department of Geriatrics, Mawangdui Hospital, Hunan, Changsha, ChinaParticipants 56 elderly patients with CHF were selected from outpatients and inpatients with coronary heart disease, hypertension or primary dilated cardiomyopathy from Feb.2007 to Dec.2008. These patients were divided into two groups by polysomnography: the research group(32 patients with CHF and OSAHS) and the control group (24 CHF patients without OSAHS). Furthermore, the research group were divided into two groups by apnea-hypopnea index(AHI):15 patients(AHI<30) and 17 patients(AHI≥30).Method After Polysomnography(PSG), we measured all subjects' left ventricular ejection fraction(LVEF) and left ventricular E/A [peak early transmitral filling velocity(E),late transmitral filling velocity(A), E/A] by doppler echocardiography, calculated myocardial performance index(Tei-index)and assessed arterial blood gas analysis. The associations between the Tei-index, LVEF, newyork heart association(NYHA) heart function classification, polysomnographic and arterial blood gas analysis parameters of each groups were examined by simple regression analysis and stepwise multiple regression analysis. Results 1.The Tei-index, LVEF, lowest oxygen saturation(LSaO2), mean oxygen saturation(MSaO2), oxygen desaturation index four(ODI4), partial pressure of carbondioxide(PaCO2), arterial oxygen saturation (SaO2) and NYHA heart function classification had statistical singnificance in the three groups of the individuals,while the E/A had not. 2.By analysis of variance, the Tei-index and LVEF had significant differences between the control group and the two research groups,and the Tei-index particularly did.The E/A had significant difference between the control group and the research group(AHI<30),but had not between the control group and the research group(AHI≥30) and either in the two research groups.3.(1)The Tei-index,ODI4 and PaCO2 had a positive correlation with AHI;the LVEF, LSaO2, MSaO2 and SaO2 had a negative correlation with AHI; the E/A had not a correlation with AHI. (2)The Tei-index had a positive correlation with NYHA heart function classification and the LVEF had a negative correlation with it, while the E/A had not a correlation with it.4. Stepwise multiple regression analysis selected AHI as independent factor for predicting the Tei-index. Stepwise multiple regression analysis selected AHI and LSaO2 as independent factor for predicting the LVEF. Stepwise multiple regression analysis selected LSaO2 and SaO2 as independent factor for predicting the NYHA heart function classification.Conclusions OSAHS has influence on left cardiac functional damage of elderly patients with CHF, severity of OSAHS is influence factor for predicting the severity of left cardiac functional damage.The Tei-index has important clinical significance for evaluating left cardiac holistic functional of elderly patients with CHF and OSAHS.