Tesi etd-11202018-071713
Link copiato negli appunti
Tipo di tesi
Corsi integrativi di I livello
Autore
BORRELLI, CHIARA
URN
etd-11202018-071713
Titolo
Central Apneas causes Ticagrelor Related Dyspnea in Patients with Acute Coronary Syndrome
Struttura
Cl. Sc. Sperimentali - Medicina
Corso di studi
SCIENZE MEDICHE - Medicina e chirurgia (DM 270)
Commissione
relatore Prof. PASSINO, CLAUDIO
Relatore Prof. EMDIN, MICHELE
Relatore Dott. GIANNONI, ALBERTO
Presidente Prof. RECCHIA, FABIO ANASTASIO
Membro Prof. LIONETTI, VINCENZO
Membro Dott.ssa ANGELONI, DEBORA
Membro Dott. MEOLA, MARIO
Membro Dott.ssa PETRUCCI, ILARIA
Membro Prof. COCEANI, FLAVIO
Relatore Prof. EMDIN, MICHELE
Relatore Dott. GIANNONI, ALBERTO
Presidente Prof. RECCHIA, FABIO ANASTASIO
Membro Prof. LIONETTI, VINCENZO
Membro Dott.ssa ANGELONI, DEBORA
Membro Dott. MEOLA, MARIO
Membro Dott.ssa PETRUCCI, ILARIA
Membro Prof. COCEANI, FLAVIO
Parole chiave
- central apnea
- chemoreflex
- dyspnea
- ticagrelor
Data inizio appello
12/12/2018;
Disponibilità
completa
Riassunto analitico
ABSTRACT
BACKGROUND Dyspnea of unknown origin often occurs in patients with acute coronary
syndrome (ACS) treated with ticagrelor.
OBJECTIVES To explore the contribution of central apneas to ticagrelor related dyspnea in
patients with ACS.
METHODS We consecutively enrolled patients with ACS, preserved left ventricular ejection
fraction and no history of obstructive sleep apnea, treated either with ticagrelor 180 mg bid (n=22)
or prasugrel 10 mg od (n=10). One week after ACS onset, all patients underwent 2-dimensional
Doppler echocardiography, pulmonary static and dynamic testing, carbon monoxide diffusion
capacity, 24-hour cardiorespiratory monitoring for hypopnea-apnea detection and chemosensitivity
to hypercapnia by rebreathing technique.
RESULTS No differences were found as concerns baseline demographic and clinical
characteristics, as well as in any echocardiographic and pulmonary data between groups treated
with ticagrelor or prasugrel. Patients treated with ticagrelor reported more frequently dyspnea (45%
versus 10%, p<0.05) and showed higher apnea-hypopnea index (AHI) and central apnea index
(CAI) during the day, the night and over the entire 24-hour period, as compared to patients treated
with prasugrel (all p<0.05). Patients treated with ticagrelor also showed higher chemosensitivity to
hypercapnia than patients treated with prasugrel (p<0.05). Among patients treated with ticagrelor,
those referring dyspnea had the highest AHI and CAI and chemosensitivity to hypercapnia (all
p<0.05).
CONCLUSIONS Central apneas should be screened for and considered a likely mechanism of
dyspnea in ACS patients treated with ticagrelor. A drug related sensitization of the chemoreflex
may be the cause of ventilatory instability in this setting.
BACKGROUND Dyspnea of unknown origin often occurs in patients with acute coronary
syndrome (ACS) treated with ticagrelor.
OBJECTIVES To explore the contribution of central apneas to ticagrelor related dyspnea in
patients with ACS.
METHODS We consecutively enrolled patients with ACS, preserved left ventricular ejection
fraction and no history of obstructive sleep apnea, treated either with ticagrelor 180 mg bid (n=22)
or prasugrel 10 mg od (n=10). One week after ACS onset, all patients underwent 2-dimensional
Doppler echocardiography, pulmonary static and dynamic testing, carbon monoxide diffusion
capacity, 24-hour cardiorespiratory monitoring for hypopnea-apnea detection and chemosensitivity
to hypercapnia by rebreathing technique.
RESULTS No differences were found as concerns baseline demographic and clinical
characteristics, as well as in any echocardiographic and pulmonary data between groups treated
with ticagrelor or prasugrel. Patients treated with ticagrelor reported more frequently dyspnea (45%
versus 10%, p<0.05) and showed higher apnea-hypopnea index (AHI) and central apnea index
(CAI) during the day, the night and over the entire 24-hour period, as compared to patients treated
with prasugrel (all p<0.05). Patients treated with ticagrelor also showed higher chemosensitivity to
hypercapnia than patients treated with prasugrel (p<0.05). Among patients treated with ticagrelor,
those referring dyspnea had the highest AHI and CAI and chemosensitivity to hypercapnia (all
p<0.05).
CONCLUSIONS Central apneas should be screened for and considered a likely mechanism of
dyspnea in ACS patients treated with ticagrelor. A drug related sensitization of the chemoreflex
may be the cause of ventilatory instability in this setting.
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