Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure

Oriana Scala, Stefania Paolillo, Roberto Formisano, Teresa Pellegrino, Giuseppe Rengo, Paola Gargiulo, Fausto De Michele, Antonio Starace, Antonio Rapacciuolo, Valentina Parisi, Maria Prastaro, Valentina Piscopo, Santo Dellegrottaglie, Dario Bruzzese, Fabiana De Martino, Antonio Parente, Dario Leosco, Bruno Trimarco, Alberto Cuocolo, Pasquale Perrone-Filardi

Research output: Contribution to journalArticle

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Abstract

Objective Unfavourable effects of sleep-disordered breathing (SDB) in heart failure (HF) are mainly mediated by impaired sympathetic activity. Few data are available on SDB and cardiac adrenergic impairment evaluated at myocardial level. The aim of the study was to assess the relationship between SDB, cardiac sympathetic innervation assessed by 123I-metaiodobenzylguanidine (123I-MIBG) imaging and prognosis in HF. Methods Observational, prospective study enrolling patients with HF and reduced systolic function. Patients underwent nocturnal cardiorespiratory monitoring to assess SDB presence by apnoea/hypopnoea index (AHI), and 123I-MIBG imaging to calculate heart-tomediastinum (H/M) ratios and washout rate. Patients were prospectively followed for 29±18 months for the combined endpoint of cardiovascular death and HF hospitalisation. Results Ninety-four patients (66.1±9.8 years; left ventricular ejection fraction 32±7%) were enrolled; 72 (77%) showed SDB and, compared with non-SDB, significantly reduced early (1.67±0.22 vs 1.77±0.13; p=0.019) and late H/M ratios (1.50±0.22 vs 1.61±0.23; p=0.038). Dividing patients into two groups according to SDB severity, patients with a moderate-severe disturbance (AHI >15; n=43) showed significantly worse survival for the composite study outcome (log-rank test, p=0.001) with respect to patients with mild or no disorder (AHI =15; n=51). Adding SDB variables to the already known prognostic role of 123I-MIBG imaging, we observed a worse survival in patients with both SDB and H/M impairment. Conclusions Patients with systolic HF and SDB show more impaired cardiac adrenergic innervation assessed by 123I-MIBG imaging, and more adverse prognosis compared with HF patients without SDB.

Original languageEnglish
JournalHeart
DOIs
Publication statusAccepted/In press - Jun 23 2016

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Sleep Apnea Syndromes
Adrenergic Agents
Heart Failure
Apnea
Systolic Heart Failure
Survival
Stroke Volume
Observational Studies
Respiration
Hospitalization
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure. / Scala, Oriana; Paolillo, Stefania; Formisano, Roberto; Pellegrino, Teresa; Rengo, Giuseppe; Gargiulo, Paola; De Michele, Fausto; Starace, Antonio; Rapacciuolo, Antonio; Parisi, Valentina; Prastaro, Maria; Piscopo, Valentina; Dellegrottaglie, Santo; Bruzzese, Dario; De Martino, Fabiana; Parente, Antonio; Leosco, Dario; Trimarco, Bruno; Cuocolo, Alberto; Perrone-Filardi, Pasquale.

In: Heart, 23.06.2016.

Research output: Contribution to journalArticle

Scala, O, Paolillo, S, Formisano, R, Pellegrino, T, Rengo, G, Gargiulo, P, De Michele, F, Starace, A, Rapacciuolo, A, Parisi, V, Prastaro, M, Piscopo, V, Dellegrottaglie, S, Bruzzese, D, De Martino, F, Parente, A, Leosco, D, Trimarco, B, Cuocolo, A & Perrone-Filardi, P 2016, 'Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure', Heart. https://doi.org/10.1136/heartjnl-2015-309215
Scala, Oriana ; Paolillo, Stefania ; Formisano, Roberto ; Pellegrino, Teresa ; Rengo, Giuseppe ; Gargiulo, Paola ; De Michele, Fausto ; Starace, Antonio ; Rapacciuolo, Antonio ; Parisi, Valentina ; Prastaro, Maria ; Piscopo, Valentina ; Dellegrottaglie, Santo ; Bruzzese, Dario ; De Martino, Fabiana ; Parente, Antonio ; Leosco, Dario ; Trimarco, Bruno ; Cuocolo, Alberto ; Perrone-Filardi, Pasquale. / Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure. In: Heart. 2016.
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abstract = "Objective Unfavourable effects of sleep-disordered breathing (SDB) in heart failure (HF) are mainly mediated by impaired sympathetic activity. Few data are available on SDB and cardiac adrenergic impairment evaluated at myocardial level. The aim of the study was to assess the relationship between SDB, cardiac sympathetic innervation assessed by 123I-metaiodobenzylguanidine (123I-MIBG) imaging and prognosis in HF. Methods Observational, prospective study enrolling patients with HF and reduced systolic function. Patients underwent nocturnal cardiorespiratory monitoring to assess SDB presence by apnoea/hypopnoea index (AHI), and 123I-MIBG imaging to calculate heart-tomediastinum (H/M) ratios and washout rate. Patients were prospectively followed for 29±18 months for the combined endpoint of cardiovascular death and HF hospitalisation. Results Ninety-four patients (66.1±9.8 years; left ventricular ejection fraction 32±7{\%}) were enrolled; 72 (77{\%}) showed SDB and, compared with non-SDB, significantly reduced early (1.67±0.22 vs 1.77±0.13; p=0.019) and late H/M ratios (1.50±0.22 vs 1.61±0.23; p=0.038). Dividing patients into two groups according to SDB severity, patients with a moderate-severe disturbance (AHI >15; n=43) showed significantly worse survival for the composite study outcome (log-rank test, p=0.001) with respect to patients with mild or no disorder (AHI =15; n=51). Adding SDB variables to the already known prognostic role of 123I-MIBG imaging, we observed a worse survival in patients with both SDB and H/M impairment. Conclusions Patients with systolic HF and SDB show more impaired cardiac adrenergic innervation assessed by 123I-MIBG imaging, and more adverse prognosis compared with HF patients without SDB.",
author = "Oriana Scala and Stefania Paolillo and Roberto Formisano and Teresa Pellegrino and Giuseppe Rengo and Paola Gargiulo and {De Michele}, Fausto and Antonio Starace and Antonio Rapacciuolo and Valentina Parisi and Maria Prastaro and Valentina Piscopo and Santo Dellegrottaglie and Dario Bruzzese and {De Martino}, Fabiana and Antonio Parente and Dario Leosco and Bruno Trimarco and Alberto Cuocolo and Pasquale Perrone-Filardi",
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T1 - Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure

AU - Scala, Oriana

AU - Paolillo, Stefania

AU - Formisano, Roberto

AU - Pellegrino, Teresa

AU - Rengo, Giuseppe

AU - Gargiulo, Paola

AU - De Michele, Fausto

AU - Starace, Antonio

AU - Rapacciuolo, Antonio

AU - Parisi, Valentina

AU - Prastaro, Maria

AU - Piscopo, Valentina

AU - Dellegrottaglie, Santo

AU - Bruzzese, Dario

AU - De Martino, Fabiana

AU - Parente, Antonio

AU - Leosco, Dario

AU - Trimarco, Bruno

AU - Cuocolo, Alberto

AU - Perrone-Filardi, Pasquale

PY - 2016/6/23

Y1 - 2016/6/23

N2 - Objective Unfavourable effects of sleep-disordered breathing (SDB) in heart failure (HF) are mainly mediated by impaired sympathetic activity. Few data are available on SDB and cardiac adrenergic impairment evaluated at myocardial level. The aim of the study was to assess the relationship between SDB, cardiac sympathetic innervation assessed by 123I-metaiodobenzylguanidine (123I-MIBG) imaging and prognosis in HF. Methods Observational, prospective study enrolling patients with HF and reduced systolic function. Patients underwent nocturnal cardiorespiratory monitoring to assess SDB presence by apnoea/hypopnoea index (AHI), and 123I-MIBG imaging to calculate heart-tomediastinum (H/M) ratios and washout rate. Patients were prospectively followed for 29±18 months for the combined endpoint of cardiovascular death and HF hospitalisation. Results Ninety-four patients (66.1±9.8 years; left ventricular ejection fraction 32±7%) were enrolled; 72 (77%) showed SDB and, compared with non-SDB, significantly reduced early (1.67±0.22 vs 1.77±0.13; p=0.019) and late H/M ratios (1.50±0.22 vs 1.61±0.23; p=0.038). Dividing patients into two groups according to SDB severity, patients with a moderate-severe disturbance (AHI >15; n=43) showed significantly worse survival for the composite study outcome (log-rank test, p=0.001) with respect to patients with mild or no disorder (AHI =15; n=51). Adding SDB variables to the already known prognostic role of 123I-MIBG imaging, we observed a worse survival in patients with both SDB and H/M impairment. Conclusions Patients with systolic HF and SDB show more impaired cardiac adrenergic innervation assessed by 123I-MIBG imaging, and more adverse prognosis compared with HF patients without SDB.

AB - Objective Unfavourable effects of sleep-disordered breathing (SDB) in heart failure (HF) are mainly mediated by impaired sympathetic activity. Few data are available on SDB and cardiac adrenergic impairment evaluated at myocardial level. The aim of the study was to assess the relationship between SDB, cardiac sympathetic innervation assessed by 123I-metaiodobenzylguanidine (123I-MIBG) imaging and prognosis in HF. Methods Observational, prospective study enrolling patients with HF and reduced systolic function. Patients underwent nocturnal cardiorespiratory monitoring to assess SDB presence by apnoea/hypopnoea index (AHI), and 123I-MIBG imaging to calculate heart-tomediastinum (H/M) ratios and washout rate. Patients were prospectively followed for 29±18 months for the combined endpoint of cardiovascular death and HF hospitalisation. Results Ninety-four patients (66.1±9.8 years; left ventricular ejection fraction 32±7%) were enrolled; 72 (77%) showed SDB and, compared with non-SDB, significantly reduced early (1.67±0.22 vs 1.77±0.13; p=0.019) and late H/M ratios (1.50±0.22 vs 1.61±0.23; p=0.038). Dividing patients into two groups according to SDB severity, patients with a moderate-severe disturbance (AHI >15; n=43) showed significantly worse survival for the composite study outcome (log-rank test, p=0.001) with respect to patients with mild or no disorder (AHI =15; n=51). Adding SDB variables to the already known prognostic role of 123I-MIBG imaging, we observed a worse survival in patients with both SDB and H/M impairment. Conclusions Patients with systolic HF and SDB show more impaired cardiac adrenergic innervation assessed by 123I-MIBG imaging, and more adverse prognosis compared with HF patients without SDB.

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