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Assessment of Cardiac Dysfunction in Patients With Chronic Obstructive Pulmonary Disease (COPD): A Cross-Sectional
Rehab A Mohammed1,2, Layla A Mohamed3, Eman M Abdelsalam1
1Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY.
Insights
Cardiac abnormalities are common in patients with chronic obstructive pulmonary disease (COPD). Echocardiography, pulmonary function tests, arterial blood gas, and brain natriuretic peptide levels can help predict cardiovascular dysfunction in COPD patients.
Area of Science:
- Cardiology
- Pulmonology
- Medical Diagnostics
Background:
- Cardiovascular diseases (CVDs) are prevalent in patients with chronic obstructive pulmonary disease (COPD).
- Comorbid CVDs in COPD patients often go undiagnosed or undertreated due to insufficient guideline-recommended screening.
- This study investigates cardiac function and prognostic indicators in COPD patients without a prior history of heart disease.
Purpose of the Study:
- To evaluate cardiac function in moderate to very severe COPD patients using echocardiography.
- To assess spirometry, arterial blood gas (ABG) analysis, and brain natriuretic peptide (BNP) as prognostic indicators of cardiovascular dysfunction.
- To identify predictors of right ventricular (RV) and left ventricular (LV) dysfunction in this population.
Main Methods:
- One hundred moderate to very severe COPD patients (GOLD guidelines) were recruited from Saudi Arabia.
- Evaluations included electrocardiography (ECG), chest X-ray, BNP, pulmonary function tests, ABG analysis, and transthoracic echocardiography.
- Multiple linear regression analysis was employed to determine predictors of RV and LV dysfunction.
Main Results:
- Pulmonary hypertension (PH) was found in 28% of patients; 25% had abnormal tricuspid annular plane systolic excursion (TAPSE).
- Left ventricular ejection fraction (LVEF) and strain were abnormal in 20%, right ventricular strain in 17%, and fractional area change (FAC) in 9%.
- Age, diabetes, hyperlipidemia, hypoxemia, hypercapnia, forced vital capacity (FVC), and BNP levels were significant predictors of cardiac dysfunction.
Conclusions:
- Cardiac abnormalities are frequent in moderate to very severe COPD patients.
- Echocardiography is a valuable tool for assessing cardiac function in COPD patients, even without a history of heart disease.
- Pulmonary function, ABG, and BNP provide additional predictive information regarding cardiac function in COPD.
Background:
Cardiovascular diseases (CVDs) are frequent in patients having chronic obstructive pulmonary disease (COPD). Despite that, comorbid CVDs receive less guideline-recommended screening in this population compared to others. We aimed to evaluate the cardiac function using echocardiography and to assess spirometry, arterial blood gas (ABG) as well as brain natriuretic peptide (BNP) as prognostic indicators of cardiovascular dysfunction in COPD patients.
Methods:
One hundred moderate to very severe COPD patients according to GOLD guidelines with no history of cardiac diseases were recruited from two hospitals in Saudi Arabia and evaluated using electrocardiography (ECG), chest X-ray, BNP, pulmonary functions, ABG analysis, and transthoracic echocardiography. Multiple linear regression analysis was used to determine the predictors of right ventricular (RV) and left ventricular (LV) dysfunction.
Results:
Pulmonary hypertension (PH) was detected in 28% of the patients, while 25% had abnormal tricuspid annular plane systolic excursion (TAPSE). Low left ventricular ejection fraction (LVEF) and abnormal LV strain were present in 20%, abnormal right ventricular strain was present in 17%, and abnormal fractional area change (FAC) was detected in 9% of patients. Multiple linear regression analysis was used to explore possible determinants of cardiac function. Age, gender, and the presence of diabetes and hyperlipidemia were significant predictors of cardiac dysfunction in COPD patients. Forced vital capacity (FVC) was an independent predictor of LVEF (odds ratio, OR: 0.424, confidence interval, 95 CI%: 0.025-0.505, p<0.031) and FAC (OR: 0.496, 95 CI%: 0.008-655). Hypoxemia and hypercapnia significantly predict both RV and LV dysfunctions. BNP was an independent predictor of FAC (OR: 0.307, 95 CI%: -0.021, p<0.001).
Conclusion:
Cardiac abnormalities are common in moderate to very severe COPD patients. Echocardiography could be considered for the assessment of these patients even in the absence of a history of cardiac disease. Pulmonary functions, ABG, and BNP may offer additional predictive information on cardiac functions in COPD patients.
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