Unrecognised ventricular dysfunction in COPD

Abstract

While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients.We used a prospective cohort study including stable o60-yr-old patients with echocardiographically confirmed CHF (n5201) and stable o60-yr-old patients with clinically and spirometryconfirmed COPD (n5218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs.The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p50.053). The presence of airway obstruction in patients with CHF did not influence survival.CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients.

Italian survey on prevalence and disease management of chronic heart failure and chronic obstructive pulmonary disease comorbidity in ambulatory patients. SUSPIRIUM study rationale and design

“…Still fewer are the studies regarding COPD outpatients (Table 2), and the prevalence of unrecognized CHF ranges from 17% (in highly selected cohorts in whom diagnosis was adjudicated retrospectively [10]) to 20.5% [11]. In Italy, to our knowledge, no studies on CHF prevalence in COPD outpatients exist.…”

“…As highlighted by Table 1, few studies have systematically examined pulmonary function in stable CHF outpatients using standardized criteria, and the Abbreviation: COPD= chronic obstructive pulmonary disease; pts= patients; y= years; PFT= pulmonary function tests; HR= hazard ratio; GPs= general practitioners; CHF=chronic heart failure; MACE= major adverse cardiac event; CV=cardiovascular observed prevalence of COPD ranges from 25 [9] -37.7% [10]. Still fewer are the studies regarding COPD outpatients (Table 2), and the prevalence of unrecognized CHF ranges from 17% (in highly selected cohorts in whom diagnosis was adjudicated retrospectively [10]) to 20.5% [11].…”

Chronic Obstructive Pulmonary Disease and Heart Failure: Closer than Close

“…A recent US study showed that among 219 patients discharged from a tertiary centre with both diagnoses of COPD and HF, 82% received echocardiography, as opposed to only 36% of patients who received pulmonary function testing, which is much less expensive and time consuming than comprehensive echocardiography 16 . In their prospective REPENSAR study, Macchia et al found that only 6.5% of cardiologists and 12% of pulmonologists had certifi ed or ruled out COPD in patients with CHF, or vice versa 17 . COPD independently predicted failure of the ejection fraction of left ventricle (EFLV) assessment by echocardiography during hospital stay in the Italian TEMISTOCLE study 18 .…”

Bisoprolol in COPD study

“…People with COPD are more likely to have associated comorbidities [4], including ischaemic heart disease [5], hypertension [6], heart failure, diabetes [7], metabolic syndrome, osteoporosis [8], depression [9] and lung cancer [10], which increase morbidity and complicate its management [11]. Unrecognised heart failure has been reported in up to 20% of COPD patients [12,13].…”