Relationship of hyperlipidemia to comorbidities and lung function in COPD: Results of the COSYCONET cohort

Kahnert, Kathrin; Lucke, Tanja; Huber, Rudolf M.; Behr, Jürgen; Biertz, Frank; Vogt, Anja; Watz, Henrik; Alter, Peter; Fähndrich, Sebastian; Bals, Robert; Holle, Rolf; Karrasch, Stefan; Söhler, Sandra; Wacker, Margarethe; Ficker, Joachim H.; Parhofer, Klaus G.; Vogelmeier, Claus; Jörres, Rudolf A.

doi:10.1371/journal.pone.0177501

Cited by 39 publications

(24 citation statements)

References 30 publications

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“…Given these multiple interdependences between parameters, we aimed to determine their relative importance in a network of associations via SEM, which is an extension of multiple regression and factor analysis [14, 16]. The SEM that showed the best fit and which represented a consistent and interpretable network of relationships is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

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Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

et al. 2019

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Background COPD influences cardiac function and morphology. Changes of the electrical heart axes have been largely attributed to a supposed increased right heart load in the past, whereas a potential involvement of the left heart has not been sufficiently addressed. It is not known to which extent these alterations are due to changes in lung function parameters. We therefore quantified the relationship between airway obstruction, lung hyperinflation, several echo- and electrocardiographic parameters on the orientation of the electrocardiographic (ECG) P, QRS and T wave axis in COPD. Methods Data from the COPD cohort COSYCONET were analyzed, using forced expiratory volume in 1 s (FEV 1 ), functional residual capacity (FRC), left ventricular (LV) mass, and ECG data. Results One thousand, one hundred and ninety-five patients fulfilled the inclusion criteria (mean ± SD age: 63.9 ± 8.4 years; GOLD 0–4: 175/107/468/363/82). Left ventricular (LV) mass decreased from GOLD grades 1–4 ( p = 0.002), whereas no differences in right ventricular wall thickness were observed. All three ECG axes were significantly associated with FEV 1 and FRC. The QRS axes according to GOLD grades 0–4 were (mean ± SD): 26.2° ± 37.5°, 27.0° ± 37.7°, 31.7° ± 42.5°, 46.6° ± 42.2°, 47.4° ± 49.4°. Effects of lung function resulted in a clockwise rotation of the axes by 25°-30° in COPD with severe airway disease. There were additional associations with BMI, diastolic blood pressure, RR interval, QT duration and LV mass. Conclusion Significant clockwise rotations of the electrical axes as a function of airway obstruction and lung hyperinflation were shown. The changes are likely to result from both a change of the anatomical orientation of the heart within the thoracic cavity and a reduced LV mass in COPD. The influences on the electrical axes reach an extent that could bias the ECG interpretation. The magnitude of lung function impairment should be taken into account to uncover other cardiac disease and to prevent misdiagnosis. Electronic supplementary material The online version of this article (10.1186/s12931-019-1025-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…To disentangle the multiple relationships between the measured variables, structural equation modelling (SEM) was employed [14, 16, 17, 28, 29]. The construct named “ECG axes” comprised the P wave, QRS and T wave axes.…”

Section: Methodsmentioning

confidence: 99%

Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

et al. 2019

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“…Importantly, this did not lead to a change of the role played by UA in our network. Higher values of BMI were associated with higher values of FEV 1 , which is a common finding in COPD [ 19 ]. At the same time, there were associated with higher levels of UA, however UA itself had a negative effect on FEV 1 , pointing towards greater airflow limitation.…”

Section: Discussionmentioning

confidence: 99%

“…mediated) effects. A common approach is path analysis [ 18 ] which has recently been used in COPD research to deal with such situations [ 19 , 20 ]. Path analysis is particularly capable of integrating the results of a whole set of regression analyses and eliminating non-causal associations.…”

Section: Methodsmentioning

confidence: 99%

Uric acid, lung function, physical capacity and exacerbation frequency in patients with COPD: a multi-dimensional approach

et al. 2018

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BackgroundRecent investigations showed single associations between uric acid levels, functional parameters, exacerbations and mortality in COPD patients. The aim of this study was to describe the role of uric acid within the network of multiple relationships between function, exacerbation and comorbidities.MethodsWe used baseline data from the German COPD cohort COSYCONET which were evaluated by standard multiple regression analyses as well as path analysis to quantify the network of relations between parameters, particularly uric acid.ResultsData from 1966 patients were analyzed. Uric acid was significantly associated with reduced FEV1, reduced 6-MWD, higher burden of exacerbations (GOLD criteria) and cardiovascular comorbidities, in addition to risk factors such as BMI and packyears. These associations remained significant after taking into account their multiple interdependences. Compared to uric acid levels the diagnosis of hyperuricemia and its medication played a minor role.ConclusionWithin the limits of a cross-sectional approach, our results strongly suggest that uric acid is a biomarker of high impact in COPD and plays a genuine role for relevant outcomes such as physical capacity and exacerbations. These findings suggest that more attention should be paid to uric acid in the evaluation of COPD disease status.

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“…AreaVol s3, ratio area/volume of phase 3; COPD, chronic obstructive pulmonary disease; FEF 50 , forced expired flow at 50% of vital capacity; FEV 1 , forced expiratory volume in 1 s; FVC, forced vital capacity; RV, residual volume; s3, slope of expiratory phase 3; s3/s2, ratio of slopes of phases 3 and 2; TLC, total lung capacity; Vol s2, volume of phase 2. DOI: 10.1159/000507098 gression analysis and is suitable for combining statistical results and pathophysiological or clinical information [14][15][16][17]. It allows to treat variables as dependent and independent simultaneously and to describe direct and indirect effects within a hierarchy of relationships [18].…”

Section: Discussionmentioning

confidence: 99%

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

et al. 2020

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Background: Capnovolumetry is of interest as a method for the diagnosis of obstructive airway diseases, requiring little cooperation from the patient. Objective: To help in the interpretation of capnovolumetric parameters, we aimed to identify their correspondence to conventional lung function indices. Methods: We studied 978 patients from a diagnostic study with complete functional data and the clinical diagnosis of asthma, chronic obstructive pulmonary disease (COPD), or no respiratory disease. Using path analysis, four capnovolumetric parameters (slope of expiratory phase 3, ratio of slopes of phases 3 and 2, volume of phase 2, and the ratio area/volume of phase 3) previously identified as predictors of airway obstruction in terms of spirometry and body plethysmography, were analyzed regarding their relationship to each other and the diagnostic categories of asthma or COPD versus control, or obstruction versus no obstruction. We then identified four lung function parameters showing relationships as much as possible isomorphic to those between capnovolumetric parameters. Results: The four capnovolumetric parameters were related to COPD and obstruction via both direct and indirect influences, but only two of them to asthma. Regarding the correspondence to lung function parameters, the slope of expiratory phase 3 corresponded best to the ratio of residual volume to total lung capacity, the ratio of slopes of phases 3 and 2 to forced expiratory volume in 1 s, the volume of phase 2 to forced expired flow at 50% of vital capacity, and the ratio area/volume of phase 3 to forced vital capacity. Conclusions: Our results indicated an intricate relationship of capnovolumetric parameters to each other and to airway obstruction, asthma, or COPD. The correspondence to conventional lung function measures seemed to reflect the entities lung hyperinflation, overall ventilatory impairment, bronchoconstriction, and ventilated lung volume, in that order. These findings might be helpful for clinicians in the interpretation of capnovolumetry.

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Relationship of hyperlipidemia to comorbidities and lung function in COPD: Results of the COSYCONET cohort

Cited by 39 publications

References 30 publications

Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

Uric acid, lung function, physical capacity and exacerbation frequency in patients with COPD: a multi-dimensional approach

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

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