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Endothelial Dysfunction in Acute Myocardial Infarction: A Complex Association With Sleep Health, Traditional
Mohamed Ali Hbaieb1,2,3, Salma Charfeddine4, Tarak Driss5
1Laboratory "Mobilité, Vieillissement, Exercise (MOVE) (UR20296)", Faculty of Sport Sciences, University of Poitiers, Poitiers, France.
Insights
Improving endothelial function (EndFx) after heart attack is key. Good sleep and physical activity can enhance EndFx, a predictor of cardiovascular health outcomes following acute myocardial infarction (AMI).
Area of Science:
- Cardiology
- Vascular Biology
- Sleep Medicine
Background:
- Endothelial function (EndFx) is crucial for cardiovascular (CV) health and recovery after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).
- Endothelial dysfunction (EndDys) is common in AMI patients and linked to CV risk factors and sleep disturbances.
- EndFx may serve as a predictor of short- and mid-term outcomes post-AMI.
Purpose of the Study:
- To investigate the association between endothelial function, sleep patterns, cardiorespiratory fitness, and CV risk factors in patients post-AMI.
- To assess the predictive value of endothelial function for clinical outcomes after AMI.
- To explore modifiable lifestyle factors influencing endothelial function in AMI survivors.
Main Methods:
- Endothelial function assessed using the Endothelium Quality Index (EQI) in 63 AMI patients.
- Sleep quality and quantity evaluated via actigraphy and the Pittsburgh Sleep Quality Index.
- Cardiorespiratory fitness measured by the 6-minute walking test; cardiac function by left ventricular ejection fraction.
Main Results:
- A high prevalence of endothelial dysfunction (EndDys) was observed post-AMI (severe: 23.8%, mild: 63.49%).
- EndDys significantly correlated with CV risk factors (physical activity, age, smoking) and poorer sleep quality/efficiency.
- Severe EndDys was linked to reduced cardiorespiratory fitness and a higher incidence of major adverse cardiac events during follow-up.
Conclusions:
- Adequate sleep and physical activity are important modifiable factors for enhancing endothelial function post-AMI.
- Endothelial function is a valuable predictive tool for outcomes following acute myocardial infarction.
- Further research is needed to identify additional predictors of CV risk in this patient population.
Background:
Endothelial function (EndFx) is a core component of cardiovascular (CV) health and cardioprotection following acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).
Hypothesis:
AMI patients experience endothelial dysfunction (EndDys), associated with traditional CV risk factors and sleep patterns. EndFx may also predict short and mid-term outcomes.
Methods:
EndFx was assessed in 63 patients (56.2 ± 7.6 years) using the Endothelium Quality Index (EQI). Sleep quality and quantity were evaluated using objective (actigraphy) and subjective (Pittsburgh Sleep Quality Index questionnaire) measures. Cardiorespiratory fitness was quantified through the 6-min walking test. Cardiac function was assessed using the left ventricular ejection fraction.
Results:
Following AMI, patients tended to experience EndDys (EQI = 1.4 ± 0.7). A severe EndDys was observed in 23.8% of patients (n = 15), while a mild EndDys was present in 63.49% (n = 40). Furthermore, EndDys was significantly associated with traditional CV risk factors (i.e., low physical activity level [12.8%], age [-4.2%], and smoking [-0.7%]) (R2 adjusted = 0.50, p < 0.001). Patients with EndDys had poor sleep quality (p = 0.001) and sleep efficiency (p = 0.016) compared to healthy persons. Patients with severe EndDys exhibited lower cardiorespiratory fitness compared to those with healthy EndFx (p = 0.017). Furthermore, during a follow-up period (nearly 4 months) following PCI, major adverse cardiac events were observed in four patients with severe EndDys.
Conclusions:
Our results emphasize the importance of adequate sleep and an active lifestyle, notably physical activity practice, as modifiable elements to enhance EndFx, which is regarded as a predictive tool following AMI. However, other factors remain to be elucidated as predictors of CV risk.
Trial Registration:
The study protocol was registered in the Pan African Clinical Trial Registry under the trial ID: PACTR202208834230748.
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