Nocturnal hypoxemic burden in patients with heart failure: Emerging prognostic role of its nonspecific component

IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2024-07-06 DOI:10.1016/j.ahj.2024.06.011
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Abstract

Background

Nocturnal hypoxemic burden has been shown to be a robust, independent predictor of all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF) and to occur in a severe form even in patients with low or negligible frequency of respiratory events (apneas/hypopneas). This suggests the existence of two components of hypoxemic burden: one unrelated to respiratory events and the other related. The aim of this study was to characterize these two components and to evaluate their prognostic value.

Methods

Nocturnal hypoxemic burden was assessed in a cohort of 280 patients with HFrEF by measuring the percentage of sleep with an oxygen saturation (SpO2) <90% (T90), and the area of the SpO2 curve below 90% (Area90). Both indices were also recalculated within the sleep segments associated with respiratory events (event-related component: T90Eve, Area90Eve) and outside these segments (nonspecific component: T90Nspec, Area90Nspec). The outcome of the survival analysis (Cox regression) was all-cause mortality.

Results

During a median follow-up of 60 months, 87 patients died. T90, Area90, and their components were significant in univariate analysis (P < .05 all). However, when these indices were adjusted for known risk factors, T90, T90Nspec, Area90, and Area90Nspec remained statistically significant (P = .018, hazard ratio (HR)=1.12, 95%CI=(1.02, 1.23); P = .007, HR=1.20, 95% CI = [1.05, 1.37]; P = .020, HR = 1.05, 95% CI = [1.01, 1.10]; P = .0006, HR = 1.15, 95% CI = [1.06, 1.25]), whereas T90Eve and Area90Eve did not (P = .27, P = .28). These results were internally validated using bootstrap resampling.

Conclusions

By demonstrating a significant independent association of nonspecific hypoxemic burden with all-cause mortality, this study suggests that this component of total nocturnal hypoxemic burden may play an important prognostic role in patients with HFrEF.

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心力衰竭患者的夜间低氧血症负担:非特异性成分的新预后作用
背景:研究表明,夜间低氧血症负担是心力衰竭和射血分数降低(HFrEF)患者全因死亡率的一个可靠、独立的预测因素,即使在呼吸事件(呼吸暂停/低通气)发生频率较低或可以忽略不计的患者中,夜间低氧血症负担也会以严重的形式出现。这表明低氧负担存在两个组成部分:一个与呼吸事件无关,另一个与之相关。本研究旨在确定这两个因素的特征,并评估其预后价值:方法:通过测量血氧饱和度(SpO2)2曲线低于90%的睡眠时间百分比(Area90),对280名HFrEF患者的夜间低氧血症负担进行评估。在与呼吸事件相关的睡眠片段(事件相关部分:T90Eve、Area90Eve)和这些片段以外的睡眠片段(非特异性部分:T90Nspec、Area90Nspec)中,也对这两个指数进行了重新计算。生存分析(Cox 回归)的结果是全因死亡率:结果:在中位 60 个月的随访期间,87 名患者死亡。在单变量分析中,T90、Area90 及其组成部分均具有显著性(pNspec、Area90 和 Area90Nspec 仍具有统计学意义(p=0.018,危险比(HR)=1.12,95%CI=(1.02,1.23);P=0.007,HR=1.20,95%CI=(1.05,1.37);P=0.020,HR=1.05,95%CI=(1.01,1.10);P=0.0006,HR=1.15,95%CI=(1.06,1.25)),而 T90Eve 和 Area90Eve 没有统计学意义(P=0.27,P=0.28)。这些结果通过引导重采样得到了内部验证:本研究通过证明非特异性低氧血症负担与全因死亡率之间存在显著的独立关联,表明夜间总低氧血症负担的这一部分可能对高频低氧血症患者的预后起着重要作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American heart journal
American heart journal 医学-心血管系统
CiteScore
8.20
自引率
2.10%
发文量
214
审稿时长
38 days
期刊介绍: The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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