Obstructive Sleep Apnea Is Associated with Increased Myocardial Scar Burden in Patients with Obstructive Hypertrophic...

Obstructive sleep apnea (OSA) is frequent in patients with hypertrophic cardiomyopathy (HCM). Late gadolinium enhancement (LGE) reflects myocardial scarring, which is significantly associated with adverse clinical events in patients with HCM. However, whether OSA is associated with increased myocardial scar burden in these patients remain unclear.

We prospectively studied 223 consecutive patients with obstructive HCM at Fuwai and Anzhen Hospitals between September 2018 and 2023. All patients underwent polysomnography and cardiac magnetic resonance (CMR) imaging.

Myocardial scarring (quantified by LGE%, LGE, % of LV mass) increased with OSA severity (p < 0.001 across non-OSA, mild OSA, and moderate-severe OSA groups). Additionally, we compared clinical variables across LGE% tertiles. The apnea hypopnea index (AHI) was significantly higher with increasing LGE%. A history of syncope (p = 0.05), left atrial diameter (p = 0.03), and left ventricular end-diastolic diameter (p = 0.03) also increased with LGE%. In multiple linear regression between LGE% and significant variables from Spearman analysis, we found that the presence of OSA, severity of OSA, and AHI were independently associated with the severity of myocardial scarring reflected by LGE% after adjusting for age, sex, and body mass index.

After adjusting for clinical variables, AHI, OSA presence, and severity were associated with increased myocardial scar burden (reflected by LGE%) in patients with obstructive HCM. Further clinical trials are needed to assess whether OSA treatment reduces adverse clinical events in this population.