In patients with OSAS, the presence of a presystolic wave is independently associated with impaired global longitudinal strain despite preserved left ventricular ejection fraction, suggesting PSW may serve as a simple, non-invasive, and readily available echocardiographic marker of subclinical left ventricular systolic dysfunction.
Key Findings
Results
GLS was significantly impaired in PSW-positive OSAS patients compared to PSW-negative patients despite both groups maintaining normal ejection fraction.
GLS was -16.1 ± 1.9% in PSW-positive patients versus -18.1 ± 1.3% in PSW-negative patients (p < 0.001)
Left ventricular ejection fraction remained within the normal range in both groups
GLS was measured using two-dimensional speckle-tracking echocardiography
A total of 57 patients were classified as PSW-positive and 46 as PSW-negative
Results
GLS remained independently associated with PSW presence after multivariable adjustment.
OR of 2.19 (95% CI, 1.52–3.15; p < 0.001) for GLS in multivariable logistic regression
Adjusted for apnea-hypopnea index, body mass index, waist circumference, and beta-blocker use
Both univariable and multivariable logistic regression analyses were performed
Results
PSW-positive patients had significantly higher apnea-hypopnea index values and a greater prevalence of severe OSAS.
Patients with PSW had significantly higher apnea-hypopnea index values compared to those without PSW
A greater prevalence of severe OSAS was observed in the PSW-positive group
All 103 patients had polysomnography-confirmed OSAS and were prospectively enrolled
Results
Peak PSW velocity among PSW-positive patients was not significantly correlated with GLS or apnea-hypopnea index.
The median peak PSW velocity was 65 cm/s (interquartile range, 57–70 cm/s) among patients with detectable PSW
Peak PSW velocity was not significantly correlated with GLS
Peak PSW velocity was not significantly correlated with apnea-hypopnea index
Conclusions
PSW was proposed as a simple, non-invasive echocardiographic marker of subclinical left ventricular systolic dysfunction in OSAS patients.
PSW is detectable via standard Doppler echocardiography and does not require advanced imaging techniques beyond routine transthoracic echocardiography
The finding is clinically relevant because conventional LVEF may remain normal while subclinical dysfunction is present
The study enrolled 103 prospectively recruited, polysomnography-confirmed OSAS patients
What This Means
This research suggests that a particular echocardiographic finding called the presystolic wave (PSW) — a small wave visible on heart ultrasound — may indicate hidden (subclinical) heart muscle problems in people with obstructive sleep apnea (OSA). OSA is a common condition where breathing repeatedly stops during sleep, and it is known to strain the heart over time. In this study of 103 patients with confirmed OSA, those who had a detectable PSW on echocardiography showed significantly worse heart muscle function, as measured by a sensitive technique called global longitudinal strain (GLS), compared to patients without PSW. Importantly, the standard measure of heart pumping function (ejection fraction) looked normal in both groups, meaning the PSW may reveal heart problems that would otherwise go undetected.
The association between PSW presence and impaired GLS held up even after accounting for factors like sleep apnea severity, body weight, and medications, suggesting PSW independently reflects subclinical cardiac dysfunction rather than simply reflecting disease severity. Interestingly, the speed (velocity) of the PSW itself was not related to how severe the heart muscle impairment was, suggesting that the mere presence or absence of PSW — rather than its magnitude — is the clinically meaningful signal.
This research suggests that detecting a PSW during a routine heart ultrasound could help doctors identify OSA patients whose hearts are already under stress before standard tests raise any alarms. This could potentially allow for earlier intervention and monitoring in this high-risk population without requiring additional specialized testing beyond a standard echocardiogram.
Altınışık M, Gülçebi F, Ateş E, Yılmaz N, Kul S. (2026). Association of Presystolic Wave with Subclinical Left Ventricular Dysfunction in Obstructive Sleep Apnea Syndrome.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70632