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Published on: September 27, 2024
Treatable cardiac disease in hospitalised COPD exacerbations
Paul Leong1,2,3, Martin I MacDonald1,2,3, Paul T King1,2
1Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia.
Insights
Dynamic CT effectively identifies severe coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) in patients hospitalized with COPD exacerbations. This reveals significant opportunities for improved cardiac treatment and patient outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Radiology
Background:
- Acute exacerbations of COPD (AECOPD) increase cardiac risk, but diagnosing co-existing coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) is challenging.
- The true prevalence of severe CAD and HFrEF during AECOPD and the potential for treatment remain largely unknown.
Purpose of the Study:
- To determine the prevalence of severe CAD and severe HFrEF in patients hospitalized with AECOPD.
- To assess the utility of dynamic computed tomography (CT) in identifying these cardiac conditions during AECOPD.
Main Methods:
- A cross-sectional study involving 148 patients hospitalized with AECOPD.
- Dynamic CT was employed to diagnose severe CAD (Agatston score ≥400) and HFrEF (ejection fraction ≤40% for left ventricle, ≤35% for right ventricle).
Main Results:
- Severe CAD was found in 35% of patients, left ventricular systolic dysfunction in 8%, and right ventricular systolic dysfunction in 12%.
- Clinical assessment missed severe CAD in one-third and HFrEF in two-thirds of cases.
- Significant undertreatment of identified CAD and HFrEF was observed, with less than 53% receiving guideline-recommended therapies.
Conclusions:
- Dynamic CT is a valuable tool for detecting clinically silent CAD and HFrEF during AECOPD.
- Identifying these conditions presents a critical opportunity to improve patient outcomes through established cardiac treatments.
Introduction:
Acute exacerbations of COPD (AECOPD) are accompanied by escalations in cardiac risk superimposed upon elevated baseline risk. Appropriate treatment for coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) could improve outcomes. However, securing these diagnoses during AECOPD is difficult, so their true prevalence remains unknown, as does the magnitude of this treatment opportunity. We aimed to determine the prevalence of severe CAD and severe HFrEF during hospitalised AECOPD using dynamic computed tomography (CT).
Methods:
A cross-sectional study of 148 patients with hospitalised AECOPD was conducted. Dynamic CT was used to identify severe CAD (Agatston score ≥400) and HFrEF (left ventricular ejection fraction ≤40% and/or right ventricular ejection fraction ≤35%).
Results:
Severe CAD was detected in 51 of 148 patients (35%), left ventricular systolic dysfunction was identified in 12 cases (8%) and right ventricular systolic dysfunction was present in 18 (12%). Clinical history and examination did not identify severe CAD in approximately one-third of cases and missed HFrEF in two-thirds of cases. Elevated troponin and brain natriuretic peptide did not differentiate subjects with severe CAD from nonsevere CAD, nor distinguish HFrEF from normal ejection fraction. Undertreatment was common. Of those with severe CAD, only 39% were prescribed an antiplatelet agent, and 53% received a statin. Of individuals with HFrEF, 50% or less received angiotensin blockers, beta blockers or antimineralocorticoids.
Conclusion:
Dynamic CT detects clinically covert CAD and HFrEF during AECOPD, identifying opportunities to improve outcomes via well-established cardiac treatments.
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