Association between left ventricular end-diastolic volume and cardiovascular disease in systemic hypertensive patients with obstructive sleep apnea

Abstract

Background and purpose

Systemic hypertension and obstructive sleep apnea (OSA) are closely linked conditions that substantially increase the risk of cardiovascular disease (CVD). Left ventricular end-diastolic volume (LVEDV) is a crucial echocardiographic marker of cardiac remodeling; however, its prognostic value in patients with concomitant systemic hypertension and OSA remains poorly defined. This study aimed to examine the association between LVEDV and the incidence of CVD in this high-risk population.

Methods

This retrospective cohort study included patients with confirmed systemic hypertension and OSA, who were stratified into tertiles based on baseline LVEDV. Multivariable Cox proportional hazards models, adjusted for demographic factors, comorbid conditions, and OSA severity, were used to evaluate CVD risk. Sensitivity and stratified analyses were conducted to assess the robustness of the findings.

Results

A total of 1914 patients (mean age 48.7 ± 10.2 years) were followed for a median of 83 months, during which 186 incident CVD events were documented. The incidence of CVD increased progressively across LVEDV tertiles. In fully adjusted analyses, patients in the highest tertile (T3: >81 mL) showed a significantly higher risk of CVD compared with those in the lowest tertile (T1: <70 mL) (hazard ratio [HR] = 1.86; 95% confidence interval [CI]: 1.30–2.67; P = 0.001). Although a higher risk was observed for the intermediate tertile (T2: 70–81 mL), this association did not reach statistical significance (HR = 1.29; 95% CI: 0.88–1.88; P = 0.19). These associations remained stable across sensitivity and stratified analyses.

Conclusion

Elevated LVEDV is independently associated with an increased risk of CVD in patients with coexisting systemic hypertension and OSA. These findings support LVEDV as a novel and readily obtainable echocardiographic biomarker for cardiovascular risk stratification in this population. Routine assessment of LVEDV may enable earlier identification of individuals at heightened risk and inform timely preventive strategies in patients with OSA-related systemic hypertension.