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BORRELLI, CHIARA

etd-11202018-071713

Central Apneas causes Ticagrelor Related Dyspnea in Patients with Acute Coronary Syndrome

Cl. Sc. Sperimentali - Medicina

SCIENZE MEDICHE - Medicina e chirurgia (DM 270)

relatore Prof. PASSINO, CLAUDIO
Relatore Prof. EMDIN, MICHELE
Relatore Dott. GIANNONI, ALBERTO

• central apnea
• chemoreflex
• dyspnea
• ticagrelor

12/12/2018;

completa

ABSTRACT<br>BACKGROUND Dyspnea of unknown origin often occurs in patients with acute coronary<br>syndrome (ACS) treated with ticagrelor.<br>OBJECTIVES To explore the contribution of central apneas to ticagrelor related dyspnea in<br>patients with ACS.<br>METHODS We consecutively enrolled patients with ACS, preserved left ventricular ejection<br>fraction and no history of obstructive sleep apnea, treated either with ticagrelor 180 mg bid (n=22)<br>or prasugrel 10 mg od (n=10). One week after ACS onset, all patients underwent 2-dimensional<br>Doppler echocardiography, pulmonary static and dynamic testing, carbon monoxide diffusion<br>capacity, 24-hour cardiorespiratory monitoring for hypopnea-apnea detection and chemosensitivity<br>to hypercapnia by rebreathing technique.<br>RESULTS No differences were found as concerns baseline demographic and clinical<br>characteristics, as well as in any echocardiographic and pulmonary data between groups treated<br>with ticagrelor or prasugrel. Patients treated with ticagrelor reported more frequently dyspnea (45%<br>versus 10%, p&lt;0.05) and showed higher apnea-hypopnea index (AHI) and central apnea index<br>(CAI) during the day, the night and over the entire 24-hour period, as compared to patients treated<br>with prasugrel (all p&lt;0.05). Patients treated with ticagrelor also showed higher chemosensitivity to<br>hypercapnia than patients treated with prasugrel (p&lt;0.05). Among patients treated with ticagrelor,<br>those referring dyspnea had the highest AHI and CAI and chemosensitivity to hypercapnia (all<br>p&lt;0.05).<br>CONCLUSIONS Central apneas should be screened for and considered a likely mechanism of<br>dyspnea in ACS patients treated with ticagrelor. A drug related sensitization of the chemoreflex<br>may be the cause of ventilatory instability in this setting.

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