Association Between the Inflammatory Biomarkers and Left Ventricular Systolic Dysfunction in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract

Background:Cardiovascular diseases are an important cause of morbidity and mortality in chronic obstructive pulmonary disease patients. The increased inflammatory biomarker levels predict exacerbations and are associated with cardiovascular diseases in stable chronic obstructive pulmonary disease patients but their role in the settings of acute chronic obstructive pulmonary disease exacerbations has not been determined.Aims:To analyse the association between inflammatory biomarkers and heart failure and also to determine the predictors of mortality in patients with exacerbations of chronic obstructive pulmonary disease.Study Design:Prospective observational study.Methods:We analysed 194 patients admitted for acute exacerbation of chronic obstructive pulmonary disease at The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. In all patients, C-reactive protein, fibrinogen, N-terminal of the pro-hormone brain natriuretic peptide and white blood count were measured and transthoracic echocardiography was performed.Results:There were 119 men (61.3%) and the median age was 69 years (interquartile range 62-74). Left ventricular systolic dysfunction (ejection fraction <50%) was present in 47 (24.2%) subjects. Patients with left ventricular systolic dysfunction had higher C-reactive protein levels (median 100 vs. 31 mg/L, p=0.001) and fibrinogen (median 5 vs. 4 g/L, p=<0.001) compared to those with preserved ejection fraction. The overall hospital mortality was 8.2% (16/178). The levels of C-reactive protein, fibrinogen, N-terminal pro-brain natriuretic peptide and ejection fraction predicted hospital mortality in univariate analysis. After adjusting for age, hypoxemia and C-reactive protein, ejection fraction remained significant predictors of hospital mortality (OR 3.89, 95% CI 1.05-15.8).Conclusion:Nearly a quarter of patients with the exacerbation of chronic obstructive pulmonary disease present with left ventricular systolic dysfunction which may be associated with mortality.

Plasma Histone H4 and Its Further Implications in the Setting of Sepsis-related Myocardial Dysfunctıon

“…In clinical practice, septic cardiomyopathy (S-CMP) has been regarded as a poorly understood phenomenon with a variety of underlying mechanisms-including detrimental impacts of cytokines and nitric oxide on the myocardium-and generally presents with emerging systolic and/or diastolic dysfunction on transthoracic echocardiogram (TTE) in septic patients (1)(2)(3). Within this context, the association of inflammation markers, in particular, with left ventricular systolic dysfunction might also be substantiated by previous reports in diverse clinical scenarios other than sepsis (4). Interestingly, S-CMP, though renowned for its reversible nature (1), might not fully recover in certain settings, potentially suggesting some degree of permanent myocardial injury (3).…”

Plasma Histone H4 and Its Implications in the Setting of Sepsis-related Myocardial Dysfunction

“…In clinical practice, septic cardiomyopathy (S-CMP) has been regarded as a poorly understood phenomenon with a variety of underlying mechanisms-including detrimental impacts of cytokines and nitric oxide on the myocardium-and generally presents with emerging systolic and/or diastolic dysfunction on transthoracic echocardiogram (TTE) in septic patients (1)(2)(3). Within this context, the association of inflammation markers, in particular, with left ventricular systolic dysfunction might also be substantiated by previous reports in diverse clinical scenarios other than sepsis (4). Interestingly, S-CMP, though renowned for its reversible nature (1), might not fully recover in certain settings, potentially suggesting some degree of permanent myocardial injury (3).…”

Risk factors of chronic obstructive pulmonary disease exacerbations

“…Andrijevic et al reported that the most common CVDs associated with AECOPD were arterial hypertension (77.8%), systolic dysfunction (24.2%) and coronary artery disease (14.9%). Mortality was higher in patients with systolic dysfunction (19.2%) compared with subjects who had preserved ejection fraction (4.8%) …”

“…Mortality was higher in patients with systolic dysfunction (19.2%) compared with subjects who had preserved ejection fraction (4.8%). 96 In a large-scale study Jones et al 97 investigated the correlation between CVD and exacerbation rates and mortality in COPD cohort. They concluded that the presence of CVD was not associated with increased risk of exacerbations or death, but with a higher risk of hospitalisation.…”