Right ventricular echocardiographic parameters predicting the severity of sleep apnea syndrome in patients with heart failure

Sleep apnea syndrome (SAS) is a frequently occurring sleep disorder known to be associated with multiple serious cardiovascular diseases, including cardiac remodeling and dysfunction. There is limited information available regarding the impact of SAS on the right ventricle (RV) as most investigations and studies have primarily focused on the left heart. To highlight the utility of RV echocardiography parameters to predict the severity of SAS among patients with stable chronic heart failure (HF). We conducted a prospective, descriptive, monocentric study over a period of 18 months that included 85 patients with HF admitted to the cardiology department of our hospital between January 2022 and June 2023. All patients underwent a respiratory polygraphy at the Pneumology Department and a transthoracic echocardiography (TTE) with specific study of the RV echocardiographic parameters: RV free wall longitudinal strain (RVFWLS), RV fractional area change (RV FAC), right ventricular TEI index (RV TEI index), tricuspid annular plane systolic excursion (TAPSE) and Peak systolic velocity of tricuspid annulus (RV S’). SAS was diagnosed in a total of 71 patients (83%). The average age of our population was 69 [62–73] years old with a masculine predominance (sex ratio = 3.7). Mean left ventricular ejection fraction (LVEF) was 38% [33–52]. 69% of the patients (n = 49) had mild and moderate SAS, while 31% (n = 22) had severe SAS. In the univariate analysis, RV Tei index with a cutoff value > 0.50 (OR = 3; 95% CI = 1.06–8.56; p = 0.035) was correlated with the severity of apnea-hypopnea index (AHI). Additionally, a RV FAC < 40 (sensitivity of 67%, specificity of 68%) increased the likelihood of having severe SAS (OR = 4; 95% CI = 1.38–11; p = 0.09). In the multivariate analysis, the RVFWLS, with a cutoff value of −17 (sensitivity of 66%, specificity of 78%) was the only independent predictor for SAS severity (95% CI 0.752–0.977; p = 0.021). RVFWLS, seems to be a strong predictor of SAS severity in patients with stable chronic HF.