Ischemic ECG abnormalities are associated with an increased risk for death among subjects with COPD, also among those
Ulf Nilsson1, Anders Blomberg1, Bengt Johansson1
1Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
Insights
Ischemic ECG abnormalities (I-ECG) increase mortality risk in COPD patients, even without prior heart disease. This finding highlights the prognostic value of I-ECG in COPD for predicting death.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Cardiovascular comorbidity is a significant contributor to mortality in Chronic Obstructive Pulmonary Disease (COPD).
- The prognostic implications of electrocardiogram (ECG) abnormalities in COPD populations are not well-established in population-based studies.
Purpose of the Study:
- To evaluate the impact of ischemic ECG abnormalities (I-ECG) on mortality in individuals with COPD.
- To compare mortality risks between COPD patients with I-ECG and individuals with normal lung function (NLF).
Main Methods:
- Population-based cohorts identified individuals with COPD (FEV1/VC <0.70) and age/sex-matched referents.
- A re-examination included spirometry and 12-lead ECGs, with mortality data collected over a median follow-up of 7 years.
- ECGs were Minnesota-coded, and mortality data were analyzed to assess 5-year cumulative mortality and adjusted risk ratios.
Main Results:
- Ischemic ECG abnormalities (I-ECG) were similarly prevalent in both COPD and NLF groups.
- Five-year cumulative mortality was significantly higher in individuals with I-ECG in both COPD (29.6%) and NLF (17.1%) groups compared to those without I-ECG.
- COPD patients with I-ECG exhibited an increased risk of death (adjusted HR 1.89), independent of FEV1 % predicted and common confounders, and this risk was also present in those without prior heart disease.
Conclusions:
- Ischemic ECG abnormalities (I-ECG) are associated with an elevated risk of mortality in COPD patients.
- The prognostic value of I-ECG in COPD is independent of disease severity and common confounding factors.
- I-ECG holds prognostic significance for mortality risk even in individuals with COPD who have no previously diagnosed heart disease.
Abstract Presentation:
An abstract, including parts of the results, has been presented at an oral session at the European Respiratory Society International Conference, London, UK, September 2016.
Background:
Cardiovascular comorbidity contributes to increased mortality among subjects with COPD. However, the prognostic value of ECG abnormalities in COPD has rarely been studied in population-based surveys.
Aim:
To assess the impact of ischemic ECG abnormalities (I-ECG) on mortality among individuals with COPD, compared to subjects with normal lung function (NLF), in a population-based study.
Methods:
During 2002-2004, all subjects with FEV1/VC <0.70 (COPD, n=993) were identified from population-based cohorts, together with age- and sex-matched referents without COPD. Re-examination in 2005 included interview, spirometry, and 12-lead ECG in COPD (n=635) and referents [n=991, whereof 786 had NLF]. All ECGs were Minnesota-coded. Mortality data were collected until December 31, 2010.
Results:
I-ECG was equally common in COPD and NLF. The 5-year cumulative mortality was higher among subjects with I-ECG in both groups (29.6% vs 10.6%, P<0.001 and 17.1% vs 6.6%, P<0.001). COPD, but not NLF, with I-ECG had increased risk for death assessed as the mortality risk ratio [95% confidence interval (CI)] when compared with NLF without I-ECG, 2.36 (1.45-3.85) and 1.65 (0.94-2.90) when adjusted for common confounders. When analyzed separately among the COPD cohort, the increased risk for death associated with I-ECG persisted after adjustment for FEV1 % predicted, 1.89 (1.20-2.99). A majority of those with I-ECG had no previously reported heart disease (74.2% in NLF and 67.3% in COPD) and the pattern was similar among them.
Conclusion:
I-ECG was associated with an increased risk for death in COPD, independent of common confounders and disease severity. I-ECG was of prognostic value also among those without previously known heart disease.
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