Heart failure with preserved ejection fraction-like phenotype in coronary artery disease and obstructive sleep apnea: insights from the RICCADSA cohort

Abstract

Background Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF‐like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity. Methods A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea–hypopnea index (AHI) ≥ 15 events/h. HFpEF‐like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e′ ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT‐proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI). Results Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m 2 ; 69.9% met HFpEF‐like criteria. Age and obesity were independently associated with HFpEF‐like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005–1.033) and ODI (OR 1.030, 95% CI 1.010–1.050) were significant predictors. Conclusions HFpEF‐like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep‐related factors. Pre‐registered Clinical Trial Number The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige—Research and Development in Sweden; registration no. VGSKAS‐4731; April 29, 2005).