Cardiopulmonary Coupling in Chronic Obstructive Pulmonary Disease

Rahaghi, Farbod N.; Beek, Edwin Jacques Rudolph van; Washko, George R.

doi:10.1097/rti.0000000000000076

Cited by 16 publications

(14 citation statements)

References 84 publications

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“…COPD is associated with pulmonary hypertension, ventricular dysfunction, atherosclerosis, and heart failure. Early diagnosis and monitoring are enhanced with improved imaging techniques and are vital in ensuring better mortality outcomes 25,26. ECG and echocardiography screenings can serve as early detection to cardiovascular events and subsequent analysis may show structural and functional cardiac abnormalities in COPD patients.…”

Section: Discussionmentioning

confidence: 99%

Czech multicenter research database of severe COPD

Novotná¹,

Koblížek²,

Zatloukal³

et al. 2014

COPD

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PurposeChronic obstructive pulmonary disease (COPD) has been recognized as a heterogeneous, multiple organ system-affecting disorder. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) places emphasis on symptom and exacerbation management. The aim of this study is examine the course of COPD and its impact on morbidity and all-cause mortality of patients, with respect to individual phenotypes and GOLD categories. This study will also evaluate COPD real-life patient care in the Czech Republic.Patients and methodsThe Czech Multicentre Research Database of COPD is projected to last for 5 years, with the aim of enrolling 1,000 patients. This is a multicenter, observational, and prospective study of patients with severe COPD (post-bronchodilator forced expiratory volume in 1 second ≤60%). Every consecutive patient, who fulfils the inclusion criteria, is asked to participate in the study. Patient recruitment is done on the basis of signed informed consent. The study was approved by the Multicentre Ethical Committee in Brno, Czech Republic.ResultsThe objective of this paper was to outline the methodology of this study.ConclusionThe establishment of the database is a useful step in improving care for COPD subjects. Additionally, it will serve as a source of data elucidating the natural course of COPD, comorbidities, and overall impact on the patients. Moreover, it will provide information on the diverse course of the COPD syndrome in the Czech Republic.

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Section: Discussionmentioning

confidence: 99%

Czech multicenter research database of severe COPD

Novotná¹,

Koblížek²,

Zatloukal³

et al. 2014

COPD

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“…While Echocardiography (ECHO) and cardiac magnetic resonance imaging (MRI) are often used to study cardiac structure and function in COPD 3 , these are not routinely deployed in all smokers. Computed tomographic (CT) imaging of the chest is broadly utilized in clinical care and is increasingly used for lung cancer screening in high risk smokers 4 .…”

Section: Introductionmentioning

confidence: 99%

Ventricular Geometry From Non-contrast Non-ECG-gated CT Scans

Rahaghi

Vegas-Sánchez-Ferrero

Minhas

et al. 2017

Academic Radiology

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Background Imaging based assessment of cardiovascular structure and function provides clinically relevant information in smokers. Non-cardiac gated thoracic computed tomographic (CT) scanning is increasingly leveraged for clinical care and lung cancer screening. We sought to determine if more comprehensive measures of ventricular geometry could be obtained from CT using an atlas based surface model of the heart. Methods Subcohorts of 24 subjects with cardiac MRI and 262 subjects with echocardiography were identified from COPDGene, a longitudinal observational study of smokers. A surface model of the heart was manually initialized, and then automatically optimized to fit the epicardium for each CT. Estimates of right and left ventricular (RV and LV) volume and free wall curvature were then calculated and compared with structural and functional metrics obtained from MRI and echocardiograms. Results CT measures of RV dimension and curvature correlated with similar measures obtained using MRI. RV and LV volume obtained from CT were inversely related with echocardiogrambased estimates of right ventricular systolic pressure using tricuspid regurgitation jet velocity (RVSP) and LV ejection fraction (LVEF) respectively. Patients with evidence of RV or LV dysfunction on echocardiogram had larger RV and LV dimensions on CT. Logistic regression models based on demographics and ventricular measures from CT had an area under the curve (AUC) of > 0.7 for the prediction of elevated RVSP and ventricular failure. These data suggest that non-cardiac gated, non-contrast enhanced thoracic CT scanning may provide insight into cardiac structure and function in smokers.

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“…COPD causes permanent changes in the lung parenchyma, and has hemodynamic repercussions, such as pulmonary hypertension, left ventricular dysfunction, and atherosclerosis, leading to significant morbidity and worsening of the prognosis of the disease 11. The increase in intrathoracic pressure caused by PEEPi reduces both the preload of the right and left ventricles and left ventricular compliance, and can increase right ventricular afterload and pulmonary vascular resistance 2,12.…”

Section: Introductionmentioning

confidence: 99%

“…Major variations in intrathoracic pressure and lung volume have acute hemodynamic effects, directly influencing venous return 14–16. Echocardiography, a simple, cost-effective, noninvasive assessment method,16 is able to detect cardiac abnormalities and acute hemodynamic effects 11. In a recent study, Houben-Wilke et al17 evaluated 514 patients referred to pulmonary rehabilitation and demonstrated that more than half of these had echocardiographic abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Positive end-expiratory pressure attenuates hemodynamic effects induced by an overload of inspiratory muscles in patients with COPD

Schaper-Magalhães¹,

Pinho²,

Capuruço³

et al. 2017

COPD

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BackgroundInspiratory muscle training (IMT) using a Threshold® device is commonly used to improve the strength and endurance of inspiratory muscles. However, the effect of IMT, alone or with positive end-expiratory pressure (PEEP), on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) remains unknown.ObjectiveTo assess the effects of an overload of inspiratory muscles using IMT fixed at 30% of the maximal inspiratory pressure (MIP), and IMT associated with 5 cmH2O of PEEP (IMT + PEEP), on the echocardiographic parameters in healthy subjects and patients with COPD.MethodsTwenty patients with COPD (forced expiratory volume in 1 second 53.19±24.71 pred%) and 15 age-matched healthy volunteers were evaluated using spirometry, MIP, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. The E- (fast-filling phase) and A- (atrial contraction phase) waves were evaluated at the tricuspid and mitral valves during inspiration and expiration in the following sequence: at basal conditions, using IMT, and using IMT + PEEP.ResultsPatients with COPD had reduced MIPs versus the control group. Ten patients had CAT scores <10 and 12 patients had mMRC scores <2. E-wave values at the mitral valve were significantly decreased with IMT during the inspiratory phase in both groups. These effects were normalized with IMT + PEEP. During the expiratory phase, use of IMT + PEEP normalized the reduction in E-wave values in the COPD group. During inspiration at the tricuspid valve, reduction in E-wave values during IMT was normalized by IMT + PEEP in COPD group. During the expiratory phase, the value of the E-waves was significantly reduced with overload of the inspiratory muscles in both groups, and these effects were normalized with IMT + PEEP. A-waves did not change under any conditions.ConclusionAcute hemodynamic effects induced by overloading of the inspiratory muscles were attenuated and/or reversed by the addition of PEEP in COPD patients.

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Cardiopulmonary Coupling in Chronic Obstructive Pulmonary Disease

Cited by 16 publications

References 84 publications

Czech multicenter research database of severe COPD

Czech multicenter research database of severe COPD

Ventricular Geometry From Non-contrast Non-ECG-gated CT Scans

Positive end-expiratory pressure attenuates hemodynamic effects induced by an overload of inspiratory muscles in patients with COPD

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