Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease

Marčun, Robert; Šustić, Alan; Brguljan, Pika Meško; Kadivec, Saša; Farkaš, Jerneja; Košnik, Mitja; Coats, Andrew J.S.; Anker, Stefan D.; Lainščak, Mitja

doi:10.1016/j.ijcard.2012.05.044

Cited by 57 publications

(59 citation statements)

References 32 publications

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“…In subjects admitted to the hospital with an acute exacerbation of COPD, elevated NT-proBNP levels are associated with a significantly higher 30-day mortality [35]. We also recently reported that increased NT-proBNP levels, measured on hospital admission of patients with COPD, are associated with an unfavorable outcome during a 6-month follow-up [36].…”

Section: Discussionmentioning

confidence: 90%

Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease

et al. 2015

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Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p < 0.05 for all comparisons). HFpEF was not independently associated with all-cause mortality [hazard ratio (HR) 1.07, 95 % confidence interval (CI) 0.44-2.62]. Global initiative for chronic Obstructive Lung Disease (GOLD) stage (IV vs. I-III, HR 2.37, CI 1.23-4.59) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels (HR 2.79, CI 1.12-6.98) were independent predictors of long-term survival. HFpEF is present in one-fifth of patients with exacerbated COPD. Non-invasively diagnosed HFpEF may not be an independent predictor of all-cause mortality. Elevated NT-proBNP levels and very severe COPD were independently associated with unfavorable overall survival.

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Section: Discussionmentioning

confidence: 90%

Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease

et al. 2015

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“…Ventricular arrhythmias and atrial fibrillation were independent predictors of mortality in a cohort of 580 patients having COPD as primary disease who were hospitalized in the respiratory unit of a university hospital from 1981 to 1990 [Odds ratio (OR) = 1.91, 1.10-3.31 and 2.27, 1.14-4.51, respectively] [32]. Several studies aimed to measure the incidence of left ventricular dysfunction in COPD exacerbations found a significant association between elevated brain natriuretic peptide or N-terminal fragment proNT-pro brain natriuretic peptide and increased cardiovascular mortality [33][34][35][36] Cardiovascular disease also leads to hospitalization of COPD patients, left ventricular dysfunction may be present in more than 30 % of acute dyspnea episodes in COPD patients attended at the emergency room or admitted to the hospital [33,[35][36][37]. In the Lung Health Study [27] cardiovascular causes accounted for 42 % of first hospitalizations and 44 % of second hospitalizations, while respiratory causes accounted for only 14 % of admissions [27].…”

Section: Impact Of Cardiovascular Disease In Copd Outcomesmentioning

confidence: 99%

“…In the Lung Health Study [27] cardiovascular causes accounted for 42 % of first hospitalizations and 44 % of second hospitalizations, while respiratory causes accounted for only 14 % of admissions [27]. Raised troponin levels during an acute COPD exacerbation appears to increase the risk of further admissions [34,36] Impact of copd on cardiovascular diseases outcome From the cardiac perspective there is strong epidemiological evidence showing that the forced expiratory volume in the first second [38] (FEV 1 ) is a marker for cardiovascular mortality [39][40][41][42][43][44][45]. It has been estimated that for every 10 % decrease in FEV 1 , cardiovascular mortality increases by 28 % and non-fatal coronary events by almost 20 % [39].…”

Section: Impact Of Cardiovascular Disease In Copd Outcomesmentioning

confidence: 99%

Beta-blockers in patients with chronic obstructive disease and coexistent cardiac illnesses

Álvarez-Sala

Miguel-Díez

2015

COPD Res Pract

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Chronic obstructive pulmonary disease is prevalent condition commonly associated with cardiovascular diseases. When both are combined the prognosis of the patient worsens. One cornerstone therapy for most cardiac diseases is beta-blockade, however concerns about its potential harmful effects on airways function often restrains their use in patients with COPD and coexistent cardiac diseases. While selective beta 1 adrenergic blockers seem to have a better safety profile, other non-selective beta-blockers can be securely utilized in stable COPD patients with no or little reactivity when they are indispensable and used with caution. Evidence provided by post hoc analysis of clinical trials and large observational studies suggests a beneficial effect of beta-blockers on mortality and exacerbations in mild to moderate COPD patients. Benefits are less obvious in severe COPD. Studies on the actual use of beta-blockers suggest that many cardiac patients with COPD (or vice versa) who can benefit from beta-blocker utilization do not receive such medication as it is recommended in the guidelines because of die-hard, not justified in most cases, concerns on safety.

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“…(2013) 61:469-481 475 elevated troponin T and elevated NT-proBNP in acute settings (without pulmonary embolism or acute coronary event or obvious heart failure) might help clinicians assess prognosis, but at the moment there is insufficient data for making recommendations about their influence in changing the treatment of acute exacerbation of COPD. In a very recent study, Marcun et al (2012) reported that discharge troponin T predicted hospitalizations (hazard ratio: 2.89, 95 % confidence interval: 1.13-7.36) and that admission NT-proBNP predicted mortality. The mid-regional pro-atrial natriuretic peptide (MRproANP) has a much longer half life than mature ANP and has been suggested as a more reliable analyte for measurement.…”

Section: Biomarkers Of Cardiac Involvementmentioning

confidence: 99%

Blood Specimen Biomarkers of Inflammation, Matrix Degradation, Angiogenesis, and Cardiac Involvement: a Future Useful Tool in Assessing Clinical Outcomes of COPD Patients in Clinical Practice?

Kristan

2013

Arch. Immunol. Ther. Exp.

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Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible; this airflow limitation is both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gasses. COPD is undoubtedly an umbrella term, and it seems unlikely that all patients with COPD have the same underlying disease processes; thus, there is a need for differential treatment of different subgroups. A potential solution is to find modifiable biomarkers that can assist in drug development and distinguish subgroups of COPD. With the exception of lung function tests, there are currently no well-validated biomarkers or surrogate endpoints that can be used to establish the efficacy of a drug for COPD. This article discusses biomarkers of inflammation (fibrinogen, C-reactive protein, pulmonary and activation-regulated chemokine/CC-chemokine ligand-18, serum surfactant protein D, interleukin (IL)-6, IL-8 and tumor necrosis factor a, complement factor C5a), angiogenesis factors as a part of the pathogenetic aspect in this disease (vascular endothelial growth factor, angiogenin, and IL-8), and matrix degradation biomarkers. Troponin and natriuretic peptides are presented as biomarkers of cardiac involvement in the light of COPD comorbidities. Trials based on research on known clinical variables such as FEV1, BODE, and 6MWT in combination with biomarkers from lung and blood specimens will probably clarify part of the prognosis and natural history of the disease. This will also represent an additional step in COPD phenotyping and new treatment possibilities.

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Cardiac biomarkers predict outcome after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease

Cited by 57 publications

References 32 publications

Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease

Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease

Beta-blockers in patients with chronic obstructive disease and coexistent cardiac illnesses

Blood Specimen Biomarkers of Inflammation, Matrix Degradation, Angiogenesis, and Cardiac Involvement: a Future Useful Tool in Assessing Clinical Outcomes of COPD Patients in Clinical Practice?

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