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Central pulsatile haemodynamics in COPD: a propensity score-matched evaluation of cohorts
Matthias Helmut Urban1,2, Thomas Weber3, Siegfried Wassertheurer4
1Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.
Insights
Patients with Chronic Obstructive Pulmonary Disease (COPD) have increased cardiovascular risk. Central hemodynamics, specifically Forward Wave Amplitude (FWA), are elevated in COPD patients and linked to lung hyperinflation.
Area of Science:
- Cardiology
- Pulmonology
- Biomedical Engineering
Background:
- Cardiovascular risk is significantly higher in patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD).
- Central hemodynamic measurements using wave separation analysis offer a promising method to assess cardiovascular risk, independent of peripheral blood pressure limitations.
- These central hemodynamic parameters have not been extensively studied in the context of COPD.
Purpose of the Study:
- To investigate central hemodynamic parameters in patients with COPD.
- To explore the association between central hemodynamics and lung function, particularly hyperinflation, in COPD patients.
Main Methods:
- A cross-sectional evaluation utilizing propensity score matching compared COPD patients (n=80 from ELASTIC trial) with non-COPD controls (n=2307 from Heinz Nixdorf studies).
- Central hemodynamics, including Forward Wave Amplitude (FWA) and Backward Wave Amplitude (BWA), were measured noninvasively via wave separation analysis.
- Associations between hemodynamic parameters and lung hyperinflation (residual volume to total lung capacity ratio) were assessed using multivariable regression.
Main Results:
- Matched analysis revealed significantly greater FWA in COPD patients compared to controls (Cohen's d = 0.423).
- BWA was greater in unmatched COPD patients but not significantly different after matching.
- Multivariable regression demonstrated an independent association between FWA and lung hyperinflation (standardized β = -0.188) in COPD patients.
Conclusions:
- COPD is associated with increased Forward Wave Amplitude (FWA), potentially contributing to heightened cardiovascular risk.
- The elevated FWA in COPD patients appears to correlate with the severity of lung hyperinflation.
Background:
Cardiovascular risk is elevated in patients with COPD. Central haemodynamic measurements via wave separation analysis indicate cardiovascular risk independent of well-known limitations of peripheral blood pressure measurements, but have not yet been studied in COPD. We aimed to investigate central haemodynamics and their association with lung function in patients with COPD.
Methods:
In this cross-sectional evaluation of cohort studies, we used propensity score matching to compare COPD patients from the randomised ELASTIC trial (n=80) to subjects without airflow limitation and cardiovascular diseases from the Heinz Nixdorf Recall study (n=2307) and the Heinz Nixdorf Multi-Generation Study (n=2625). Central haemodynamics were measured noninvasively via wave separation analysis. Forward wave amplitude (FWA) and backward wave amplitude (BWA) were compared between patients and controls matched for age, sex, hypertension and smoking, and were assessed for associations with lung hyperinflation.
Results:
From the initial study cohorts, we identified 75 pairs of COPD patients and matched controls. We found greater FWA in patients than in matched controls (Cohen's d 0.423, 95% confidence interval (CI) 0.098-0.746). BWA was greater in patients than in unmatched controls (Cohen's d 0.333, 95% CI 0.104-0.562), but did not differ after matching (Cohen's d 0.128, 95% CI -0.193-0.448). On multivariable regression FWA was independently associated with hyperinflation expressed as residual volume to total lung capacity ratio (standardised β -0.188, 95% CI -0.335- -0.037) in patients with COPD.
Conclusion:
COPD is associated with greater FWA which may contribute to increased cardiovascular risk and appears to be correlated with the degree of hyperinflation in patients with COPD.
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