Sleep Apnea and Cardiac Structure and Function in Patients With Heart Failure with Preserved Ejection Fraction: Insights From the PARAGON-HF Trial.

BACKGROUND

Sleep apnea is common in patients with heart failure with preserved ejection fraction (HFpEF). However, the impact of sleep apnea on cardiac structure, function, and outcomes is not well understood. We assessed clinical outcomes and echocardiographic characteristics in participants of the PARAGON-HF echocardiographic substudy.

METHODS

PARAGON-HF was a randomized clinical trial of sacubitril/valsartan vs valsartan in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) ≥45%. Echocardiographic variables were adjusted for clinically relevant parameters at baseline. The risk of total HF hospitalization (HFH) and cardiovascular (CV) death by sleep apnea status was analyzed using the semiparametric method of Lin, Wei, Yang, and Ying (LWYY).

RESULTS

Among 1097 patients in the PARAGON-HF echocardiographic substudy, 133 (12.1%) had a reported history of sleep apnea. Those with sleep apnea were younger (72 vs 74 years), more often men (64% vs 45%), and had a higher body mass index (33 vs 29 kg/m2). They also had a higher prevalence of diabetes (53% vs 39%) and lower diastolic blood pressure. At baseline, those with sleep apnea had greater adjusted left ventricular (LV) mass index (93 vs 87 g/m²), worse absolute LV global longitudinal strain (15% vs 16%), and worse absolute right ventricular (RV) free wall longitudinal strain (17% vs 19%). Patients with sleep apnea experienced a higher risk of HFH and CV death than those without (adjusted risk ratio = 1.57, 95% CI 1.05, 2.35, P = 0.029), independent of LVEF (P = 0.92).

CONCLUSIONS

Patients with HFpEF and sleep apnea exhibited evidence of LV remodeling, subclinical biventricular myocardial dysfunction, and an increased risk of adverse CV events compared to those without sleep apnea, regardless of LVEF.