Rapid Fire Session

Session: Rapid Fire Session 2: Multicenter Clinical Trials and Cardiomyopathy (Monitor 10)

Impact of Multimodal Right Ventricular Assessment in Patients with Resistant Hypertension and Obstructive Sleep Apnea

Thursday, February 5, 2026

4:13 PM - 4:20 PM

Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

Presenting Author(s)

Thaiz Ruberti Schmal, MD, MSc

Medical doctor and preceptor at University Hospital of Federal University of Juiz De Fora
Ebsehr - University Hospital of the Federal University of Juiz de fora
Juiz de Fora, Minas Gerais, Brazil

Co-Author(s)

Thaiz Ruberti Schmal, MD, MSc

Medical doctor and preceptor at University Hospital of Federal University of Juiz De Fora
Ebsehr - University Hospital of the Federal University of Juiz de fora
Juiz de Fora, Minas Gerais, Brazil

Primary Author(s)

LM

Leonardo H. Mendonca, Filho

Medical Resident
Federal University of São Paulo, Brazil

Co-Author(s)

PG

Pedro H.P. Guimaraes

Medical student
School of Medicine of the Federal University of Juiz de Fora, Brazil
PM

Pedro N. Martins

Medical student
School of Medicine of Federal University of Juiz de Fora, Brazil
LO

Ludimila O.C. Ouverney, MD, MSc

Medical doctor and preceptor
Ebsehr - University Hospital of Federal University of Juiz de Fora, Brazil
JC

Jose R. Castro, Jr., MD, MSc

Medical doctor and preceptor in Echocardiography
Federal University of Juiz de Fora, Brazil
GL

Geraldo Lorenzi, PhD

Professor of Pneumology and Director of Sleeping Lab Disorders
Sao Paulo University, Brazil
TS

Thiago G.S. Souza, PhD

Medical doctor and preceptor at University Hospital of Federal University of Juiz De Fora
Ebserh - University Hospital of Federal University of Juiz de Fora, Brazil

Background: Obstructive sleep apnea (OSA) is strongly associated with left ventricular (LV) remodeling and dysfunction in severe cases. However, evidence on right ventricular (RV) changes remain limited, particularly from multimodality imaging in patients with both resistant hypertension and OSA. The main objective of this study was to evaluate the impact of OSA on RV structural and functional parameters according to hypoxic burden (SASHB).

Methods: In this cross-sectional study (September 2022–April 2024), 88 patients with resistant hypertension were screened, and 68 were enrolled after applying exclusion criteria (LVEF < 50%, atrial fibrillation, contraindications to cardiac magnetic resonance [CMR]). SASHB was derived from home sleep apnea testing (HSAT) and calculated as the area under all OSA-related oxygen desaturation curves, normalized by total sleep time (%·min/h). Echocardiography assessed tricuspid annular plane systolic excursion (TAPSE), while CMR quantified RV mass, indexed end-diastolic volume (RVEDVi), and RV ejection fraction (RVEF). Missing data were addressed with multiple imputation (m=5). Linear regression was applied to continuous outcomes, and logistic regression to categorical outcomes, both using restricted cubic splines and adjusted for age, sex, BMI, LVEF, smoking, and type 2 diabetes.

Results: The mean age of participants was 58.9±10.1 years; 19% were male, and mean BMI was 32.9±6.8 kg/m². SASHB was not significantly associated with any RV parameters. RV mass was independently and positively associated with male sex (β = 8.12; 95% CI 0.64–15.60; p = 0.035) and type 2 diabetes (β = 6.84; 95% CI 1.55–12.12; p = 0.013), and demonstrated a nonlinear association with age (p = 0.002). RVEF was positively associated with male sex (β = 2.60; 95% CI 0.44–4.77; p = 0.019). RVEDVi also showed a nonlinear association with age (p = 0.002). TAPSE was significantly correlated with LVEF (β = 0.50; 95% CI 0.17–0.82; p = 0.005). Overall, 51.7% of patients presented LV myocardial fibrosis (38.3% non-ischemic and 13.3% ischemic).

Conclusion: This study evaluated the impact of OSA quantified by SASHB on RV parameters and found no significant associations. Instead, demographic and systemic factors—particularly age, sex, and LVEF—were more strongly related to RV structure and function, although mean values remained within normal limits. While the LV appears more consistently affected by OSA, multimodality RV assessment adds incremental insight, suggesting that RV changes in this high-risk group may reflect the broader cardiovascular context rather than OSA-related hypoxemia alone.

Baseline Characteristics and Hypoxic Burden (Univariate Analyses)

Variable	SASHB < 60	SASHB ≥60	Type	Beta	CI 95%	p-value
IMC	31.2 ± 6.9	34.8 ± 6.2	Beta	3.64	0.43 - 6.85	0.027
Age	57.4 ± 11.3	60.4 ± 8.9	Beta	3.06	-1.89 - 8.02	0.221
Smoking	23 (63.9%)	25 (78.1%)	OR	2.02	0.67 - 6.06	0.207
Passive Smoking	29 (80.6%)	28 (87.5%)	OR	1.69	0.43 - 6.58	0.444
Sex	30 (83.3%)	25 (78.1%)	OR	0.71	0.21 - 2.46	0.588

Cardiac Magnetic Resonance — Description and Model (pool)

Variable	CH < 60	CH ≥ 60	Beta	CI 95%	p-value
Interventricular Septum Thickness (mm)	11.8 ± 2.7	13.0 ± 2.9	1.06	-0.65 - 2.77	0.213
Posterior Wall Thickness (mm)	8.2 ± 2.6	8.6 ± 2.6	0.17	-1.18 - 1.52	0.799
LV Ejection Fraction (%)	65.8 ± 10.7	67.9 ± 8.1	1.56	-3.65 - 6.76	0.548
LV mass (g)	112.0 ± 52.5	120.6 ± 35.3	6.23	-16.6 - 29.0	0.587
RV Major axis (mm)	65.1 ± 7.9	62.8 ± 10.6	-2.34	-7.51 - 2.84	0.366
RV Minor axis (mm)	41.3 ± 7.0	40.7 ± 7.6	-0.45	-4.34 - 3.44	0.816
RV End-Diastolic Volume (ml)	97.4 ± 25.6	101.5 ± 26.8	4.05	-9.01 - 17.1	0.537
RV End-Systolic Volume (ml)	37.8 ± 10.5	40.6 ± 14.5	3.69	-2.65 - 10.0	0.249
RV End- Diastolic Volume Index (mL/m²)	52.1 ± 12.5	51.8 ± 13.6	-0.38	-6.9 - 6.14	0.907
RV End- Systolic Volume Index (mL/m²)	20.3 ± 5.9	20.6 ± 6.1	0.70	-2.26 - 3.66	0.638
RV Ejection Fraction (%)	60.4 ± 11.3	60.5 ± 9.1	-0.97	-6.41 - 4.47	0.721
RV mass (g)	32.2 ± 10.4	35.6 ± 9.6	2.82	-2.25 - 7.89	0.270
RV/LV Mass Ratio	57.4 ± 11.3	60.4 ± 8.9	3.06	-1.89 - 8.02	0.221
LV LGE n(%)	30 (83.3%)	30 (93.8%)	2.48	0.41 - 14.7	0.310
Right Atrium Volume Index (mL/m²)	28.9 ± 8.6	29.0 ± 12.3	0.71	-5.66 - 7.09	0.822
RA Diameter (mm)	43.4 ± 5.7	42.9 ± 8.6	0.55	-3.63 - 4.73	0.791

Patient 1 - Cine and LGE Images
Patient 2 - Cine and LGE Images