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

Abstract

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.

Echocardiographic predictors of outcome in patients with chronic obstructive pulmonary disease

“…It should be underlined, however, that our study cannot determine whether the association between diastolic dysfunction and mortality in COPD patients differs from the usual association in patients with cardiac disease, because all patients had COPD. We have recently shown that elevated N‐terminal pro B‐type natriuretic peptide levels were independently associated with unfavorable overall survival in patients with an exacerbation of COPD, whereas heart failure with preserved ejection fraction, as a surrogate marker for LV diastolic dysfunction, was not …”

“…Last, our study evaluated prognostic implications of echocardiographic parameters only, adjusted for age and COPD severity. We recently reported on the prognostic implications of echocardiographic parameters within the context of heart failure with preserved ejection fraction and COPD . However, further multicenter, large‐scale studies with adequate statistical power are needed to elucidate the predictive value of echocardiographic parameters in the presence of other factors known to influence long‐term survival in patients with COPD.…”

“…We have recently shown that elevated N-terminal pro B-type natriuretic peptide levels were independently associated with unfavorable overall survival in patients with an exacerbation of COPD, whereas heart failure with preserved ejection fraction, as a surrogate marker for LV diastolic dysfunction, was not. 27 Further studies involving natriuretic peptides and invasive intracardiac pressure measurements are warranted to better delineate associations of echocardiographic indices, acute volume changes, pulmonary hypertension, and intrinsic LV dysfunction in patients with COPD.…”

Therapeutic effects of nebulized verapamil on chronic obstructive pulmonary disease: A randomized and double‐blind clinical trial

“…Given that systemic inflammation, pulmonary vasoconstriction, and polycythemia and endothelial dysfunction expose COPD patients to pulmonary hypertension, the therapeutic option which attenuates PAP can improve dyspnea score. In our study 12 (60%) patients in the verapamil group and 11 in the placebo group (55%) had a PAP higher than 35 mm Hg.…”

Biomarkers Predictive of Exacerbations in the SPIROMICS and COPDGene Cohorts

“…One key candidate is the heterogeneous nature of exacerbations, which can be triggered by myriad factors. Approximately half of exacerbations have been associated with bacterial infections by culture-dependent techniques and nearly 60% with viral infections (36), but some exacerbations may be triggered by air pollution (37), changes in temperature and barometric pressure (38,39), and possibly shifts in intrapulmonary fluids in those with occult heart failure (40). From this viewpoint, the inability to identify reproducible biomarkers follows inability to classify the etiology for each exacerbation accurately.…”