TY - JOUR
T1 - Dynamic Changes of Left Ventricular Performance and Left Atrial Volume Induced by the Mueller Maneuver in Healthy Young Adults and Implications for Obstructive Sleep Apnea, Atrial Fibrillation, and Heart Failure
AU - Orban, Marek
AU - Bruce, Charles J.
AU - Pressman, Gregg S.
AU - Leinveber, Pavel
AU - Romero-Corral, Abel
AU - Korinek, Josef
AU - Konecny, Tomas
AU - Villarraga, Hector R.
AU - Kara, Tomas
AU - Caples, Sean M.
AU - Somers, Virend K.
N1 - Funding Information:
This work was supported by grants from the National Institutes of Health HL65176 and 1 UL1 RR024150, ResMed Foundation, and Respironics Sleep and Breathing Foundation. Dr. Orban was supported by an American Physiological Society Perkins Memorial Award; Drs. Orban and Korinek were supported by a Travel Grant from the Czech Society of Cardiology; Dr. Somers is a Consultant for ResMed, Respironics, Cardiac Concepts, Glaxo Smith Kline, and Sepracor and an investigator on research grants funded by Sorin and Select Research; and Dr. Kara was supported by an Unrestricted Investigational Award to Mayo Foundation from General Electric Healthcare.
PY - 2008/12/1
Y1 - 2008/12/1
N2 - Using the Mueller maneuver (MM) to simulate obstructive sleep apnea (OSA), our aim was to investigate acute changes in left-sided cardiac morphologic characteristics and function which might develop with apneas occurring during sleep. Strong evidence supports a relation between OSA and both atrial fibrillation and heart failure. However, acute effects of airway obstruction on cardiac structure and function have not been well defined. In addition, it is unclear how OSA might contribute to the development of atrial fibrillation and heart failure. Echocardiography was used in healthy young adults to measure various parameters of cardiac structure and function. Subjects were studied at baseline, during, and immediately after performance of the MM and after a 10-minute recovery. Continuous heart rate, blood pressure, and pulse oximetry measurements were made. During the MM, left atrial (LA) volume index markedly decreased. Left ventricular (LV) end-systolic dimension increased in association with a decrease in LV ejection fraction. On release of the maneuver, there was a compensatory increase in blood flow to the left side of the heart, with stroke volume, ejection fraction, and cardiac output exceeding baseline. After 10 minutes of recovery, all parameters returned to baseline. In conclusion, sudden imposition of severe negative intrathoracic pressure led to an abrupt decrease in LA volume and a decrease in LV systolic performance. These changes reflected an increase in LV afterload. Repeated swings in afterload burden and chamber volumes may have implications for the future development of atrial fibrillation and heart failure.
AB - Using the Mueller maneuver (MM) to simulate obstructive sleep apnea (OSA), our aim was to investigate acute changes in left-sided cardiac morphologic characteristics and function which might develop with apneas occurring during sleep. Strong evidence supports a relation between OSA and both atrial fibrillation and heart failure. However, acute effects of airway obstruction on cardiac structure and function have not been well defined. In addition, it is unclear how OSA might contribute to the development of atrial fibrillation and heart failure. Echocardiography was used in healthy young adults to measure various parameters of cardiac structure and function. Subjects were studied at baseline, during, and immediately after performance of the MM and after a 10-minute recovery. Continuous heart rate, blood pressure, and pulse oximetry measurements were made. During the MM, left atrial (LA) volume index markedly decreased. Left ventricular (LV) end-systolic dimension increased in association with a decrease in LV ejection fraction. On release of the maneuver, there was a compensatory increase in blood flow to the left side of the heart, with stroke volume, ejection fraction, and cardiac output exceeding baseline. After 10 minutes of recovery, all parameters returned to baseline. In conclusion, sudden imposition of severe negative intrathoracic pressure led to an abrupt decrease in LA volume and a decrease in LV systolic performance. These changes reflected an increase in LV afterload. Repeated swings in afterload burden and chamber volumes may have implications for the future development of atrial fibrillation and heart failure.
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U2 - 10.1016/j.amjcard.2008.07.050
DO - 10.1016/j.amjcard.2008.07.050
M3 - Article
C2 - 19026314
AN - SCOPUS:56349151982
SN - 0002-9149
VL - 102
SP - 1557
EP - 1561
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 11
ER -