Background-Left atrial (LA) structure and function are altered in most heart failure (HF) patients, but there may be fundamental differences in LA properties between HF with preserved (HFpEF) and reduced ejection fraction (HFrEF

Cardiovascular diseases (CVDs) are arguably the most important comorbidities in chronic obstructive pulmonary disease (COPD). CVDs are common in people with COPD, and their presence is associated with increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. The economic burden associated with CVD in this population is considerable and the cumulative cost of treating comorbidities may even exceed that of treating COPD itself.Our understanding of the biological mechanisms that link COPD and various forms of CVD has improved significantly over the past decade. But despite broad acceptance of the prognostic significance of CVDs in COPD, there remains widespread under-recognition and undertreatment of comorbid CVD in this population. The reasons for this are unclear; however institutional barriers and a lack of evidence-based guidelines for the management of CVD in people with COPD may be contributory factors.In this review, we summarize current knowledge relating to the prevalence and incidence of CVD in people with COPD and the mechanisms that underlie their coexistence. We discuss the implications for clinical practice and highlight opportunities for improved prevention and treatment of CVD in people with COPD. While we advocate more active assessment for signs of cardiovascular conditions across all age groups and all stages of COPD severity, we suggest targeting those aged under 65 years. Evidence indicates that the increased risks for CVD are particularly pronounced in COPD patients in mid-to-late-middle-age and thus it is in this age group that the benefits of early intervention may prove to be the most effective.

Background In patients with heart failure (HF) and preserved ejection fraction (HFpEF), atrial fibrillation (AF) may predate, concur with, or develop after HFpEF diagnosis. We sought to define the temporal relationship between AF and HFpEF, identify factors associated with AF, and determine the prognostic impact of prevalent and incident AF in HFpEF. Method and Results From 1983 to 2010, 939 Olmsted County, MN residents (age 77±12years, 61% female) newly diagnosed with HFpEF (EF≥0.50) were evaluated. Baseline rhythm classification included: prior AF (>3 months before HFpEF diagnosis), concurrent AF (±3months), or sinus rhythm (SR). Incident AF (>3months after HFpEF diagnosis) and all-cause mortality were ascertained through February 2012. Prior (29%) and concurrent AF (23%) were associated with older age, higher BNP, and larger left atrial volume index at HFpEF diagnosis compared to SR. Of HFpEF patients in SR at diagnosis, 32% developed AF over a median (IQR) follow-up of 3.7(1.5–6.7) years (69 events per 1000 person-years). Age and diastolic dysfunction were positively, while statin use was inversely associated with incident AF. Using no AF as the referent, prior or concurrent AF (combined HR 1.3, 95%CI 1.0–1.6, p=0.03) and incident AF, modeled as a time-dependent covariate, (HR 2.1, 95%CI 1.4–3.0, p<0.001), were independently associated with death adjusting for pertinent covariates. Conclusions AF occurs in two-thirds of HFpEF patients at some point in the natural history and confers a poor prognosis. Further study is required to determine whether intervention for AF may improve outcomes or if statin use can prevent AF in HFpEF.