Publication detail

Effects of the Mueller Maneuver on Functional Mitral Regurgitation and Implications for Obstructive Sleep Apnea

PRESSMAN, G.S., ORBAN, M., LEINVEBER, P., PAREKH, K., SINGH, M., KARA, T., SOMERS, V.K.

Original Title

Effects of the Mueller Maneuver on Functional Mitral Regurgitation and Implications for Obstructive Sleep Apnea

Type

journal article in Web of Science

Language

English

Original Abstract

Obstructive sleep apnea is prevalent and adversely affects cardiovascular health. However, little is known of the acute effects of an obstructive apnea on cardiovascular physiology. We hypothesized that pre-existing functional mitral regurgitation (MR) would worsen during performance of a Mueller maneuver (MM) used to simulate an obstructive apnea; 15 subjects with an ejection fraction <= 35% and pre-existing functional MR were studied with Doppler echocardiography. The radius of the proximal flow convergence was used as a measure of mitral regurgitant flow. Measurements were made at baseline, during the MM, and post-MM. Areas of all 4 chambers were also measured at these time points, both in systole and diastole. Mean flow convergence radius for the group decreased significantly during the transition from the late-MM to post-MM (0.65/0.57 mm, p[0.001), implying increased MR during the MM. In addition, in 3 subjects, duration of MR increased during the MM. Right atrial (RA) areas, both systolic and diastolic, increased during the maneuver, whereas RA fractional area change decreased, indicating reduced RA emptying. Left ventricular emptying decreased early in the maneuver, probably because of the increased afterload burden, and then recovered. In conclusion, high negative intrathoracic pressure produces changes that, repeated hundreds of times per night in patients with obstructive sleep apnea, have the potential to worsen heart failure and predispose affected subjects to atrial fibrillation.

Keywords

Obstructive Sleep Apnea; Mitral regurgitation; Cardiovascular physiology

Authors

PRESSMAN, G.S., ORBAN, M., LEINVEBER, P., PAREKH, K., SINGH, M., KARA, T., SOMERS, V.K.

RIV year

2015

Released

1. 6. 2015

Publisher

Elsevier

Location

USA

ISBN

0002-9149

Periodical

AMERICAN JOURNAL OF CARDIOLOGY

Year of study

115

Number

11

State

United States of America

Pages from

1563

Pages to

1567

Pages count

5

URL

http://www.ajconline.org/article/S0002-9149(15)00905-4/abstract

BibTex

@article{BUT116705,
  author="Pavel {Leinveber}",
  title="Effects of the Mueller Maneuver on Functional Mitral Regurgitation and Implications for Obstructive Sleep Apnea",
  journal="AMERICAN JOURNAL OF CARDIOLOGY",
  year="2015",
  volume="115",
  number="11",
  pages="1563--1567",
  doi="10.1016/j.amjcard.2015.02.061",
  issn="0002-9149",
  url="http://www.ajconline.org/article/S0002-9149(15)00905-4/abstract"
}