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Choudhury P, Dasgupta S, Bhattacharyya P, Roychowdhury S, Chaudhury K. Understanding pulmonary hypertension: the need for an integrative metabolomics and transcriptomics approach. Mol Omics 2024; 20:366-389. [PMID: 38853716 DOI: 10.1039/d3mo00266g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Pulmonary hypertension (PH), characterised by mean pulmonary arterial pressure (mPAP) >20 mm Hg at rest, is a complex pathophysiological disorder associated with multiple clinical conditions. The high prevalence of the disease along with increased mortality and morbidity makes it a global health burden. Despite major advances in understanding the disease pathophysiology, much of the underlying complex molecular mechanism remains to be elucidated. Lack of a robust diagnostic test and specific therapeutic targets also poses major challenges. This review provides a comprehensive update on the dysregulated pathways and promising candidate markers identified in PH patients using the transcriptomics and metabolomics approach. The review also highlights the need of using an integrative multi-omics approach for obtaining insight into the disease at a molecular level. The integrative multi-omics/pan-omics approach envisaged to help in bridging the gap from genotype to phenotype is outlined. Finally, the challenges commonly encountered while conducting omics-driven studies are also discussed.
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Affiliation(s)
- Priyanka Choudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302, West Bengal, India.
| | - Sanjukta Dasgupta
- Department of Biotechnology, Brainware University, Barasat, West Bengal, India
| | | | | | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302, West Bengal, India.
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Dimiene I, Hoppenot D, Vajauskas D, Padervinskiene L, Rimkunas A, Zemaitis M, Barkauskiene D, Lapinskas T, Ereminiene E, Miliauskas S. Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity. J Clin Med 2024; 13:2937. [PMID: 38792478 PMCID: PMC11121926 DOI: 10.3390/jcm13102937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests' results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests' results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m2 (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study.
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Affiliation(s)
- Ieva Dimiene
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Deimante Hoppenot
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Donatas Vajauskas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.V.); (L.P.)
| | - Lina Padervinskiene
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.V.); (L.P.)
| | - Airidas Rimkunas
- Laboratory of Pulmonology, Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Marius Zemaitis
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Diana Barkauskiene
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (E.E.)
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (E.E.)
| | - Skaidrius Miliauskas
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
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Correale M, Tricarico L, Bevere EML, Chirivì F, Croella F, Severino P, Mercurio V, Magrì D, Dini F, Licordari R, Beltrami M, Dattilo G, Salzano A, Palazzuoli A. Circulating Biomarkers in Pulmonary Arterial Hypertension: An Update. Biomolecules 2024; 14:552. [PMID: 38785959 PMCID: PMC11117582 DOI: 10.3390/biom14050552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare subtype of group 1 pulmonary hypertension (PH) diseases, characterized by high pulmonary artery pressure leading to right ventricular dysfunction and potential life-threatening consequences. PAH involves complex mechanisms: vasoconstriction, vascular remodeling, endothelial dysfunction, inflammation, oxidative stress, fibrosis, RV remodeling, cellular hypoxia, metabolic imbalance, and thrombosis. These mechanisms are mediated by several pathways, involving molecules like nitric oxide and prostacyclin. PAH diagnosis requires clinical evaluation and right heart catheterization, confirming a value of mPAP ≥ 20 mmHg at rest and often elevated pulmonary vascular resistance (PVR). Even if an early and accurate diagnosis is crucial, PAH still lacks effective biomarkers to assist in its diagnosis and prognosis. Biomarkers could contribute to arousing clinical suspicion and serve for prognosis prediction, risk stratification, and dynamic monitoring in patients with PAH. The aim of the present review is to report the main novelties on new possible biomarkers for the diagnosis, prognosis, and treatment monitoring of PAH.
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Affiliation(s)
- Michele Correale
- Cardiothoracic Department, Ospedali Riuniti University Hospital, 71100 Foggia, Italy
| | - Lucia Tricarico
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (L.T.); (E.M.L.B.); (F.C.)
| | - Ester Maria Lucia Bevere
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (L.T.); (E.M.L.B.); (F.C.)
| | - Francesco Chirivì
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (L.T.); (E.M.L.B.); (F.C.)
| | - Francesca Croella
- Cardiothoracic Vascular Department, Division of Provincial Cardiology, Santissima Annunziata Hospital and Delta Hospital, Azienda Unità Sanitaria Locale di Ferrara, 44121 Ferrara, Italy;
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 00185 Rome, Italy;
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, 80138 Naples, Italy;
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant’Andrea, “Sapienza” Università degli Studi di Roma, 00161 Rome, Italy;
| | - Frank Dini
- Istituto Auxologico IRCCS, Centro Medico Sant’Agostino, Via Temperanza, 6, 20127 Milan, Italy;
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Roberto Licordari
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, 98122 Messina, Italy; (R.L.); (G.D.)
| | - Matteo Beltrami
- Arrhythmia and Electrophysiology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Giuseppe Dattilo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, 98122 Messina, Italy; (R.L.); (G.D.)
| | - Andrea Salzano
- Cardiology Unit, AORN A Cardarelli, 80131 Naples, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, S. Maria alle Scotte Hospital, University of Siena, 53100 Siena, Italy;
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Moccaldi B, De Michieli L, Binda M, Famoso G, Depascale R, Perazzolo Marra M, Doria A, Zanatta E. Serum Biomarkers in Connective Tissue Disease-Associated Pulmonary Arterial Hypertension. Int J Mol Sci 2023; 24:ijms24044178. [PMID: 36835590 PMCID: PMC9967966 DOI: 10.3390/ijms24044178] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening complication of connective tissue diseases (CTDs) characterised by increased pulmonary arterial pressure and pulmonary vascular resistance. CTD-PAH is the result of a complex interplay among endothelial dysfunction and vascular remodelling, autoimmunity and inflammatory changes, ultimately leading to right heart dysfunction and failure. Due to the non-specific nature of the early symptoms and the lack of consensus on screening strategies-except for systemic sclerosis, with a yearly transthoracic echocardiography as recommended-CTD-PAH is often diagnosed at an advanced stage, when the pulmonary vessels are irreversibly damaged. According to the current guidelines, right heart catheterisation is the gold standard for the diagnosis of PAH; however, this technique is invasive, and may not be available in non-referral centres. Hence, there is a need for non-invasive tools to improve the early diagnosis and disease monitoring of CTD-PAH. Novel serum biomarkers may be an effective solution to this issue, as their detection is non-invasive, has a low cost and is reproducible. Our review aims to describe some of the most promising circulating biomarkers of CTD-PAH, classified according to their role in the pathophysiology of the disease.
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Affiliation(s)
- Beatrice Moccaldi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Laura De Michieli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padova, Italy
| | - Marco Binda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Giulia Famoso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padova, Italy
| | - Roberto Depascale
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, 35128 Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-0498212190
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, 35128 Padova, Italy
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Santos-Gomes J, Gandra I, Adão R, Perros F, Brás-Silva C. An Overview of Circulating Pulmonary Arterial Hypertension Biomarkers. Front Cardiovasc Med 2022; 9:924873. [PMID: 35911521 PMCID: PMC9333554 DOI: 10.3389/fcvm.2022.924873] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH), also known as Group 1 Pulmonary Hypertension (PH), is a PH subset characterized by pulmonary vascular remodeling and pulmonary arterial obstruction. PAH has an estimated incidence of 15-50 people per million in the United States and Europe, and is associated with high mortality and morbidity, with patients' survival time after diagnosis being only 2.8 years. According to current guidelines, right heart catheterization is the gold standard for diagnostic and prognostic evaluation of PAH patients. However, this technique is highly invasive, so it is not used in routine clinical practice or patient follow-up. Thereby, it is essential to find new non-invasive strategies for evaluating disease progression. Biomarkers can be an effective solution for determining PAH patient prognosis and response to therapy, and aiding in diagnostic efforts, so long as their detection is non-invasive, easy, and objective. This review aims to clarify and describe some of the potential new candidates as circulating biomarkers of PAH.
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Affiliation(s)
- Joana Santos-Gomes
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Gandra
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui Adão
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Frédéric Perros
- Paris-Porto Pulmonary Hypertension Collaborative Laboratory (3PH), UMR_S 999, INSERM, Université Paris-Saclay, Paris, France
- Université Paris–Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Carmen Brás-Silva
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
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Clinical Value of FeNO for Pulmonary Hypertension Diagnosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Emerg Med Int 2022; 2022:9924047. [PMID: 35127179 PMCID: PMC8816608 DOI: 10.1155/2022/9924047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the clinical value of fractional exhaled nitric oxide (FeNO) in the diagnosis of pulmonary hypertension (PH) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods In this study, the medical records of AECOPD patients were retrospectively reviewed. The patients were divided into AECOPD and AECOPD + PH groups based on the absence or presence of PH. Moreover, FeNO and other indexes were compared between the two groups. The value of FeNO in diagnosing AECOPD with PH was determined using the ROC curve. Results A total of 83 patients were enrolled (56 in the AECOPD group and 27 in the AECOPD + PH group). The level of FeNO was significantly lower in the AECOPD + PH group than in the AECOPD group (P = 0.022). Moreover, FeNO level (25.22 ± 8.45 ppb) was higher in the mild PH subgroup than in the moderate (16.64 ± 5.67 ppb, P = 0.005) or severe (11.75 ± 2.36, P = 0.002) PH subgroups. FeNO level was positively correlated with C-reactive protein in AECOPD patients while negatively correlated with brain natriuretic peptide in the AECOPD + PH group. ROC analysis showed that the optimal cutoff value of FeNO in the diagnosis of AECOPD with PH was 24.5 ppb. Conclusion FeNO level at admission can act as an indicator for PH diagnosis in AECOPD patients.
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Moon JY, Leitao Filho FS, Shahangian K, Takiguchi H, Sin DD. Blood and sputum protein biomarkers for chronic obstructive pulmonary disease (COPD). Expert Rev Proteomics 2018; 15:923-935. [PMID: 30362838 DOI: 10.1080/14789450.2018.1539670] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a heterogeneous set of disorders, characterized by airflow limitation, and reduced lung function. Despite increasing knowledge regarding its pathophysiology, there has been limited advancement in therapeutics and the current treatment strategy is symptom management and prevention of exacerbations. Areas covered: Biomarkers represent important tools for the implementation of precision medicine. As fundamental molecules of all living processes, proteins could provide crucial information about how genes interact with the environment. Proteomics studies could act as important tools in identifying reliable biomarkers to enable a more precise therapeutic approach. In this review, we will explore the most promising blood and sputum protein biomarkers in COPD that have been consistently reported in the literature. Expert commentary: Given the complexity of COPD, no single protein biomarker has been able to improve the outcomes of COPD patients. According to preliminary studies, precision medicine in COPD will likely require a combination of different proteins in a biomarker panel for clinical translation. With advancements in current mass spectrometry techniques, an enhancement in the identification of new biomarkers will be observed, and improvements in sequence database search can fill in potential gaps between biomarker discovery and patient care.
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Affiliation(s)
- Ji-Yong Moon
- a Centre for Heart and Lung Innovation , St. Paul's Hospital & University of British Columbia , Vancouver , Canada.,b Department of Internal Medicine , Hanyang University College of Medicine , Seoul , Korea
| | - Fernando Sergio Leitao Filho
- a Centre for Heart and Lung Innovation , St. Paul's Hospital & University of British Columbia , Vancouver , Canada.,c Division of Pulmonary Medicine, Department of Medicine , Tokai University School of Medicine , Kanagawa , Japan
| | - Kimeya Shahangian
- a Centre for Heart and Lung Innovation , St. Paul's Hospital & University of British Columbia , Vancouver , Canada
| | - Hiroto Takiguchi
- a Centre for Heart and Lung Innovation , St. Paul's Hospital & University of British Columbia , Vancouver , Canada.,d Division of Respiratory Medicine (Department of Medicine) , University of British Columbia , Vancouver , Canada
| | - Don D Sin
- a Centre for Heart and Lung Innovation , St. Paul's Hospital & University of British Columbia , Vancouver , Canada.,d Division of Respiratory Medicine (Department of Medicine) , University of British Columbia , Vancouver , Canada
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Labaki WW, Xia M, Murray S, Curtis JL, Barr RG, Bhatt SP, Bleecker ER, Hansel NN, Cooper CB, Dransfield MT, Wells JM, Hoffman EA, Kanner RE, Paine R, Ortega VE, Peters SP, Krishnan JA, Bowler RP, Couper DJ, Woodruff PG, Martinez FJ, Martinez CH, Han MK. NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort. Respir Med 2018; 140:87-93. [PMID: 29957287 PMCID: PMC6084793 DOI: 10.1016/j.rmed.2018.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/30/2018] [Accepted: 06/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND High N-terminal pro-brain natriuretic peptide (NT-proBNP) during COPD exacerbations is associated with worse clinical outcomes. The prognostic value of NT-proBNP measured during clinical stability has not been well characterized. METHODS We studied SPIROMICS participants 40-80 years of age with COPD GOLD spirometric stages 1-4. The association between baseline NT-proBNP and incident COPD exacerbations within one year of follow-up was tested using zero-inflated Poisson regression models adjusted for age, gender, race, body mass index, current smoking status, smoking history, FEV1 percent predicted, COPD Assessment Test score, exacerbation history, total lung capacity on chest CT and cardiovascular disease (any of coronary artery disease, myocardial infarction or congestive heart failure). RESULTS Among 1051 participants (mean age 66.1 years, 41.4% women), mean NT-proBNP was 608.9 pg/ml. Subjects in GOLD stage D had the highest mean NT-proBNP. After one year of follow-up, 268 participants experienced one or more COPD exacerbations. One standard deviation increase in baseline NT-proBNP was associated with a 13% increase in the risk of incident exacerbations (incident risk ratio 1.13; 95% CI 1.06-1.19; p < 0.0001). This association was maintained in participants with and without cardiovascular disease. CONCLUSION Baseline NT-proBNP in COPD is an independent predictor of respiratory exacerbations, even in individuals without overt cardiac disease. The impact of detection and treatment of early cardiovascular dysfunction on COPD exacerbation frequency warrants further investigation.
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Affiliation(s)
- Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Meng Xia
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Susan Murray
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - R Graham Barr
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, NY, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, AZ, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher B Cooper
- Departments of Medicine and Physiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Richard E Kanner
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robert Paine
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA
| | - Victor E Ortega
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Stephen P Peters
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | | | - David J Couper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
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Winther JA, Brynildsen J, Høiseth AD, Strand H, Følling I, Christensen G, Nygård S, Røsjø H, Omland T. Prognostic and diagnostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from the ACE 2 study. Respir Res 2017; 18:184. [PMID: 29100503 PMCID: PMC5670515 DOI: 10.1186/s12931-017-0665-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/11/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Copeptin is a novel biomarker that predicts mortality in lower respiratory tract infections and heart failure (HF), but the diagnostic value of copeptin in acute dyspnea and the prognostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is not clear. METHOD We determined copeptin and NT-proBNP concentrations at hospital admission in 314 patients with acute dyspnea who were categorized by diagnosis. Survival was registered after a median follow-up of 816 days, and the prognostic and diagnostic properties of copeptin and NT-proBNP were analyzed in acute HF (n = 143) and AECOPD (n = 84) separately. RESULTS The median concentration of copeptin at admission was lower in AECOPD compared to acute HF (8.8 [5.2-19.7] vs. 22.2 [10.2-47.9]) pmol/L, p < 0.001), but NT-proBNP discriminated acute HF from non-HF related dyspnea more accurately than copeptin (ROC-AUC 0.85 [0.81-0.89] vs. 0.71 [0.66-0.77], p < 0.0001). Adjusted for basic risk factors, increased copeptin concentrations predicted mortality in AECOPD (HR per log (ln) unit 1.72 [95% CI 1.21-2.45], p = 0.003) and acute HF (1.61 [1.25-2.09], p < 0.001), whereas NT-proBNP concentrations predicted mortality only in acute HF (1.62 [1.27-2.06], p < 0.001). On top of a basic model copeptin reclassified a significant proportion of patients into a more accurate risk strata in AECOPD (NRI 0.60 [0.19-1.02], p = 0.004) and acute HF (0.39 [0.06-0.71], p = 0.020). CONCLUSION Copeptin is a strong prognostic marker in both AECOPD and acute HF, while NT-proBNP concentrations predict mortality only in patients with acute HF. NT-proBNP levels are superior to copeptin levels to diagnose acute HF in patients with acute dyspnea.
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Affiliation(s)
- Jacob A Winther
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Jon Brynildsen
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arne Didrik Høiseth
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Strand
- Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Ivar Følling
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ståle Nygård
- Bioinformatics Core Facility, Institute for Medical Informatics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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El Deen Mohammad RS, Laz NI, Elbatanouny MM, Elmageed KRA, Taha HKE. Effect of diuretics on the plasma brain natriuretic peptide (BNP) level in patients with an acute exacerbation of COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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11
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Kraen M, Frantz S, Nihlén U, Engström G, Löfdahl CG, Wollmer P, Dencker M. Brain natriuretic peptide levels in middle aged subjects with normal left ventricular function in relation to mild-moderate COPD. CLINICAL RESPIRATORY JOURNAL 2017; 12:1061-1067. [PMID: 28294547 DOI: 10.1111/crj.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/11/2017] [Accepted: 02/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Levels of plasma brain natriuretic peptide (BNP) have been shown to be elevated in chronic obstructive pulmonary disease (COPD) especially in connection with cor pulmonale (CP) and the late stages of the disease. BNP is also raised in left sided heart failure which sometimes coincides with COPD. Whether BNP is elevated in subjects with mild-moderate stable COPD and normal left ventricular function is not clear. OBJECTIVE To investigate BNP levels in subjects with mild-moderate COPD and normal left ventricular function. METHODS This was a cross sectional study of 450 subjects from a population-based respiratory questionnaire survey. All subjects were examined with echocardiography and spirometry and blood samples were drawn for BNP measurements. Subjects with left sided heart disease (n = 26) or echocardiographic signs of elevated filling pressure (n = 75), COPD stages III and IV (n = 5) or missing data (n = 13) were excluded. RESULTS In the final study population (n = 331) spirometry identified 86 subjects with COPD (GOLD stage I, n = 65 and GOLD stage II, n = 21). In comparison with the rest of the study population subjects with COPD were significantly older, longer and with a male predominance. In a multivariate linear regression analysis with log-normalized (lnBNP) as the dependent variable a significant correlation was found with age, left atrial volume, body surface area and haemoglobin, but not with any pulmonary variables. Even when comparing groups no significant difference could be found between the plasma levels of lnBNP in normal subjects (1.8 ± 0.7 mean ± SD, pmol/L) subjects and in COPD subjects (1.9 ± 0.7, P = 0.47). CONCLUSIONS In a population with normal left ventricular function no significant differences in BNP levels between stable mild-moderate COPD subjects and normal individuals could be found.
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Affiliation(s)
- Morten Kraen
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Sophia Frantz
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Ulf Nihlén
- Respiratory Medicine and Allergology unit, Department of Clinical Sciences, Lund, Lund University, Lund, 221 85, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology research group, Department of Clinical Science, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Claes-Göran Löfdahl
- Respiratory Medicine and Allergology unit, Department of Clinical Sciences, Lund, Lund University, Lund, 221 85, Sweden
| | - Per Wollmer
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Magnus Dencker
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
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12
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C-reactive protein and N-terminal prohormone brain natriuretic peptide as biomarkers in acute exacerbations of COPD leading to hospitalizations. PLoS One 2017; 12:e0174063. [PMID: 28328968 PMCID: PMC5362097 DOI: 10.1371/journal.pone.0174063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/02/2017] [Indexed: 01/02/2023] Open
Abstract
There are currently no accepted and validated blood tests available for diagnosing acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In this study, we sought to determine the discriminatory power of blood C-reactive protein (CRP) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in the diagnosis of AECOPD requiring hospitalizations. The study cohort consisted of 468 patients recruited in the COPD Rapid Transition Program who were hospitalized with a primary diagnosis of AECOPD, and 110 stable COPD patients who served as controls. Logistic regression was used to build a classification model to separate AECOPD from convalescent or stable COPD patients. Performance was assessed using an independent validation set of patients who were not included in the discovery set. Serum CRP and whole blood NT-proBNP concentrations were highest at the time of hospitalization and progressively decreased over time. Of the 3 classification models, the one with both CRP and NT-proBNP had the highest AUC in discriminating AECOPD (cross-validated AUC of 0.80). These data were replicated in a validation cohort with an AUC of 0.88. A combination of CRP and NT-proBNP can reasonably discriminate AECOPD requiring hospitalization versus clinical stability and can be used to rapidly diagnose patients requiring hospitalization for AECOPD.
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13
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Farouk H, Albasmi M, El Chilali K, Mahmoud K, Nasr A, Heshmat H, Abdel-Moneim S, Baligh E. Left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease: Impact of methods of assessment. Echocardiography 2017; 34:359-364. [PMID: 28165145 DOI: 10.1111/echo.13469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The prevalence of left ventricular (LV) diastolic dysfunction in patients with chronic obstructive pulmonary disease (COPD), using different echocardiographic parameters, varies widely in the literature. The highest prevalence of LV diastolic dysfunction was detected using the mitral inflow indexes that are commonly altered in these patients due to the associated tachycardia, reduced preload, and ventricular septal shift. In this study, we aimed at evaluating the impact of the used echocardiographic method of assessment on the prevalence of LV diastolic dysfunction in patients with COPD and normal LV systolic function. METHODS We studied 35 patients with COPD and 18 age-matched controls. A comprehensive approach to diagnose and grade the LV diastolic dysfunction was performed in accordance with the recommendations of the American Society of Echocardiography published in 2009. The results were compared with those of mitral inflow indexes. RESULTS LV diastolic dysfunction was reported in 20 patients using the mitral inflow indexes while in only 12 patients using the comprehensive approach (P=.021). Compared to the controls, LV diastolic dysfunction was significantly more common in patients using the mitral inflow indexes (P=.001), while no statistically significant difference was detected between both groups using the comprehensive approach (P=.1). CONCLUSION The prevalence of LV diastolic dysfunction in patients with COPD varies according to the used echocardiographic approach. Further studies are recommended to determine which approach is the most accurate in estimating the true prevalence of LV diastolic dysfunction among this group of patients.
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Affiliation(s)
- Heba Farouk
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Maged Albasmi
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Karim El Chilali
- Department of Cardiology, Essen University Hospital, Essen, Germany
| | - Kareem Mahmoud
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Abdo Nasr
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Hussein Heshmat
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Samah Abdel-Moneim
- Department of Pulmonary Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Essam Baligh
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
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14
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Hawkins NM, Khosla A, Virani SA, McMurray JJV, FitzGerald JM. B-type natriuretic peptides in chronic obstructive pulmonary disease: a systematic review. BMC Pulm Med 2017; 17:11. [PMID: 28073350 PMCID: PMC5223538 DOI: 10.1186/s12890-016-0345-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/09/2016] [Indexed: 12/29/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) have increased cardiovascular risk. Natriuretic peptides (NP) in other populations are useful in identifying cardiovascular disease, stratifying risk, and guiding therapy. Methods We performed a systematic literature review to examine NP in COPD, utilising Medline, EMBASE, and the Cochrane Library. Results Fifty one studies were identified. NP levels were lower in stable compared to exacerbation of COPD, and significantly increased with concomitant left ventricular systolic dysfunction or cor pulmonale. Elevation occurred in 16 to 60% of exacerbations and persisted in approximately one half of patients at discharge. Cardiovascular comorbidities were associated with increased levels. Levels consistently correlated with pulmonary artery pressure and left ventricular ejection fraction, but not pulmonary function or oxygen saturation. NP demonstrated high negative predictive values (0.80 to 0.98) to exclude left ventricular dysfunction in both stable and exacerbation of COPD, but relatively low positive predictive values. NP elevation predicted early adverse outcomes, but the association with long term mortality was inconsistent. Conclusion NP reflect diverse aspects of the cardiopulmonary continuum which limits utility when applied in isolation. Strategies integrating NP with additional variables, biomarkers and imaging require further investigation.
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Affiliation(s)
- Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.
| | - Amit Khosla
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - John J V McMurray
- Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - J Mark FitzGerald
- Division of Respiratory Medicine, University of British Columbia and Institute for Heart and Lung Health, Vancouver, Canada
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15
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Vallabhajosyula S, Haddad TM, Sundaragiri PR, Ahmed AA, Nawaz MS, Rayes HAA, Devineni HC, Kanmanthareddy A, McCann DA, Wichman CS, Modrykamien AM, Morrow LE. Role of B-Type Natriuretic Peptide in Predicting In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Preserved Left Ventricular Function: A 5-Year Retrospective Analysis. J Intensive Care Med 2016; 33:635-644. [PMID: 27913775 DOI: 10.1177/0885066616682232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of B-type natriuretic peptide (BNP) is less understood in the risk stratification of patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), especially in patients with normal left ventricular ejection fraction (LVEF). METHODS This retrospective study from 2008 to 2012 evaluated all adult patients with AECOPD having BNP levels and available echocardiographic data demonstrating LVEF ≥40%. The patients were divided into groups 1, 2, and 3 with BNP ≤ 100, 101 to 500, and ≥501 pg/mL, respectively. A subgroup analysis was performed for patients without renal dysfunction. Outcomes included need for and duration of noninvasive ventilation (NIV) and mechanical ventilation (MV), NIV failure, reintubation at 48 hours, intensive care unit (ICU) and total length of stay (LOS), and in-hospital mortality. Two-tailed P < .05 was considered statistically significant. RESULTS Of the total 1145 patients, 550 (48.0%) met our inclusion criteria (age 65.1 ± 12.2 years; 271 [49.3%] males). Groups 1, 2, and 3 had 214, 216, and 120 patients each, respectively, with higher comorbidities and worse biventricular function in higher categories. Higher BNP values were associated with higher MV use, NIV failure, MV duration, and ICU and total LOS. On multivariate analysis, BNP was an independent predictor of higher NIV and MV use, NIV failure, NIV and MV duration, and total LOS in groups 2 and 3 compared to group 1. B-type natriuretic peptide continued to demonstrate positive correlation with NIV and MV duration and ICU and total LOS independent of renal function in a subgroup analysis. CONCLUSION Elevated admission BNP in patients with AECOPD and normal LVEF is associated with worse in-hospital outcomes and can be used to risk-stratify these patients.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,2 Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Toufik Mahfood Haddad
- 3 Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Pranathi R Sundaragiri
- 4 Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anas A Ahmed
- 5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Muhammad Sarfraz Nawaz
- 6 Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hamza A A Rayes
- 7 Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Harish C Devineni
- 7 Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Arun Kanmanthareddy
- 3 Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Dustin A McCann
- 8 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Christopher S Wichman
- 9 Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE, USA
| | - Ariel M Modrykamien
- 10 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - Lee E Morrow
- 8 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.,11 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
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16
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Boubaker H, Grissa MH, Beltaief K, Dridi Z, Najjar MF, Bouida W, Boukef R, Marghli S, Nouira S. Systolic time intervals combined with Valsalva maneuver for the diagnosis of left ventricular dysfunction in COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2016; 11:2237-2243. [PMID: 27695311 PMCID: PMC5029838 DOI: 10.2147/copd.s96280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The goal of this study was to determine the value of systolic time intervals and their change during Valsalva maneuver (VM) in the diagnosis of left ventricular dysfunction (LVD) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods We included 166 patients admitted to the emergency department for AECOPD. Measurement of systolic time intervals included electromechanical activation time (EMAT), left ventricular ejection time (LVET), and EMAT/LVET ratio. These were performed at baseline and during the first strain phase of the VM using a computerized phonoelectrocardiographic method. The diagnosis of LVD was determined on the basis of clinical examination, echocardiography, and brain natriuretic peptide. The values of systolic time intervals were compared between patients with and without LVD; their diagnostic performance was assessed using the area under receiver operating characteristic (ROC) curve. Results Patients with LVD (n=95) had a significantly higher EMAT and lower LVET and EMAT/LVET ratio compared to patients without LVD (n=71); the area under ROC curve was 0.79, 0.88, and 0.90, respectively, for EMAT, LVET, and EMAT/LVET ratio. All baseline systolic time intervals changed significantly during VM in patients without LVD but they did not change in patients with LVD. The area under ROC curve increased to 0.84 and 0.93, respectively, for EMAT and EMAT/LVET ratio but did not change for LVET. Conclusion Simple and noninvasive measurements of systolic time intervals combined with VM could be helpful to detect or rule out LVD in patients admitted to the emergency room for COPD excacerbation. The EMAT/LVET ratio seems to have the best diagnostic value.
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Affiliation(s)
- Hamdi Boubaker
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | - Mohamed Habib Grissa
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | - Kaouther Beltaief
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | | | | | - Wahid Bouida
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
| | - Riadh Boukef
- Department of Emergency, Sahloul University Hospital, Sousse
| | - Soudani Marghli
- Department of Emergency, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Semir Nouira
- Department of Emergency, Fattouma Bourguiba University Hospital; Research Laboratory (LR12SP18), University of Monastir
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17
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Calzetta L, Orlandi A, Page C, Rogliani P, Rinaldi B, Rosano G, Cazzola M, Matera MG. Brain natriuretic peptide: Much more than a biomarker. Int J Cardiol 2016; 221:1031-8. [PMID: 27447810 DOI: 10.1016/j.ijcard.2016.07.109] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 01/02/2023]
Abstract
Brain natriuretic peptide (BNP) modulates several biological processes by activating the natriuretic peptide receptor A (NPR-A). Atria and ventricles secrete BNP. BNP increases natriuresis, diuresis and vasodilatation, thus resulting in a decreased cardiac workload. BNP and NT-proBNP, which is the biologically inactive N-terminal portion of its pro-hormone, are fast and sensitive biomarkers for diagnosing heart failure. The plasma concentrations of both BNP and NT-proBNP also correlate with left ventricular function in patients with acute exacerbation of COPD, even without history of heart failure. Several studies have been conducted in vitro and in vivo, both in animals and in humans, in order to assess the potential role of the NPR-A activation as a novel therapeutic approach for treating obstructive pulmonary disorders. Unfortunately, these studies have yielded conflicting results. Nevertheless, further recent specific studies, performed in ex vivo models of asthma and COPD, have confirmed the bronchorelaxant effect of BNP and its protective role against bronchial hyperresponsiveness in human airways. These studies have also clarified the intimate mechanism of action of BNP, represented by an autocrine loop elicited by the activation of NPR-A, localized on bronchial epithelium, and the relaxant response of the surrounding ASM, which does not expresses NPR-A. This review explores the teleological activities and paradoxical effects of BNP with regard to chronic obstructive respiratory disorders, and provides an excursus on the main scientific findings that explain why BNP should be considered much more than a biomarker.
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Affiliation(s)
- Luigino Calzetta
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Augusto Orlandi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Clive Page
- The Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| | - Paola Rogliani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Rinaldi
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe Rosano
- Cardiovascular & Cell Science Institute, St George's Hospital NHS Trust, University of London, London, United Kingdom; Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy
| | - Mario Cazzola
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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18
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Marcun R, Stankovic I, Vidakovic R, Farkas J, Kadivec S, Putnikovic B, Ilic I, Neskovic AN, Lainscak M. Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease. Intern Emerg Med 2016; 11:519-27. [PMID: 26423072 DOI: 10.1007/s11739-015-1319-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/28/2015] [Indexed: 01/14/2023]
Abstract
Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p < 0.05 for all comparisons). HFpEF was not independently associated with all-cause mortality [hazard ratio (HR) 1.07, 95 % confidence interval (CI) 0.44-2.62]. Global initiative for chronic Obstructive Lung Disease (GOLD) stage (IV vs. I-III, HR 2.37, CI 1.23-4.59) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels (HR 2.79, CI 1.12-6.98) were independent predictors of long-term survival. HFpEF is present in one-fifth of patients with exacerbated COPD. Non-invasively diagnosed HFpEF may not be an independent predictor of all-cause mortality. Elevated NT-proBNP levels and very severe COPD were independently associated with unfavorable overall survival.
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Affiliation(s)
- Robert Marcun
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Ivan Stankovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia.
| | - Radosav Vidakovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Jerneja Farkas
- Chair of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sasa Kadivec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Biljana Putnikovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Ivan Ilic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia
| | - Mitja Lainscak
- Department of Cardiology, General Hospital Celje, Oblakova cesta 5, 3000, Celje, Slovenia
- Chair of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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19
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Chen Y, Liu C, Lu W, Li M, Hadadi C, Wang EW, Yang K, Lai N, Huang J, Li S, Zhong N, Zhang N, Wang J. Clinical characteristics and risk factors of pulmonary hypertension associated with chronic respiratory diseases: a retrospective study. J Thorac Dis 2016; 8:350-8. [PMID: 27076929 DOI: 10.21037/jtd.2016.02.58] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic respiratory disease-associated pulmonary hypertension (PH) is an important subtype of PH, which lacks clinical epidemiological data in China. METHODS Six hundred and ninety three patients hospitalized from 2010 to 2013 were classified by echocardiography according to pulmonary arterial systolic pressure (PASP): mild (36≤ PASP <50 mmHg); moderate (50≤ PASP <70 mmHg) and severe (PASP ≥70 mmHg). RESULTS Dyspnea (93.51%) was the most common symptom. Hemoptysis observed in the severe group (6.42%) was significantly higher than the other two groups (P<0.05). COPD (78.35%), lung bullae (44.16%), tuberculosis (including obsolete pulmonary tuberculosis) (38.82%), and bronchiectasis (30.45%) were frequently present. Mild group occupied the highest proportion (84.7%) in COPD, while severe group occupied the highest proportion (19.3%) in pulmonary embolism (P<0.01). Age, partial pressure of oxygen (PaO2), hematocrit (HCT), partial pressure of carbon dioxide (PaCO2), increase of N-terminal pro brain natriuretic peptide (NT-proBNP) and right ventricular (RV) diameter (>20 mm) were associated with moderate-to-severe PH, while RV [odds ratio (OR) =3.53, 95% CI, 2.17-5.74], NT-proBNP (OR=2.44, 95% CI, 1.51-3.95), HCT (OR=1.03, 95% CI, 1.00-1.07) and PaCO2 (OR=1.01, 95% CI, 1.00-1.03) were independent risk factors. CONCLUSIONS PH related to respiratory diseases is mostly mild to moderate, and the severity is associated with the category of respiratory disease. Increased HCT can be an independent risk factor for PH related to chronic respiratory diseases.
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Affiliation(s)
- Yonghua Chen
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Chunli Liu
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Wenju Lu
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mengxi Li
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Cyrus Hadadi
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Elizabeth Wenqian Wang
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kai Yang
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ning Lai
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Junyi Huang
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Shiyue Li
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nanshan Zhong
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nuofu Zhang
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jian Wang
- 1 State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The Affiliated Hospital of Guangzhou Medical University, Guangdong 510120, China ; 2 Geisinger Medical Center, 100 North Academy Avenue, Danville, USA ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Cook S, Quint JK, Vasiljev M, Leon DA. Self-reported symptoms of chronic cough and breathlessness in working-age men in the city of Izhevsk, Russia: associations with cardiovascular disease risk factors and comorbidities. BMJ Open Respir Res 2015; 2:e000104. [PMID: 26793315 PMCID: PMC4709862 DOI: 10.1136/bmjresp-2015-000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Very little is known about the prevalence of respiratory symptoms or their associations with other health conditions in Russia. METHODS Between 2008 and 2010, a sample of 983 men resident in Izhevsk, Russia, took part in a cross-sectional survey. Presence of respiratory symptoms was determined from self-report of chronic productive cough and breathlessness assessed using the British Medical Research Council (MRC) breathlessness scale. Self-reported physical and mental health were measured using the 12-Item Short-Form Health Survey (SF-12). Hypertension was assessed from mean blood pressure measured at the health check and/or self-reported use of antihypertensive medication. Other comorbidities were assessed from self-report. Logistic regression models were fitted assessing the association between respiratory symptoms and comorbidities. Linear regression models were fitted to investigate the association between respiratory symptoms and self-reported health scores. All models were adjusted for age, education and smoking status. RESULTS The age-standardised prevalence of cough and breathlessness was 20.9% (prevalence with breathlessness MRC grade 3 or above 3.7%). The majority of men with respiratory symptoms (87.3%) were current smokers. Cough and breathlessness were associated with substantially worse self-reported physical and mental health (test for trend with severity of breathlessness p<0.001). Those with chronic cough and grade 3 or above breathlessness had higher odds of having hypertension (OR 3.03; 95% CI 1.36 to 6.74), diabetes (OR 10.55; 95% CI 2.69 to 41.37), angina pectoris (OR 7.54; 95% CI 3.61 to 15.73), previous myocardial infarction (OR 7.61; 95% CI 2.10 to 27.4) and previous stroke (OR 6.61; 95% CI 1.75 to 23.34) compared with those without respiratory symptoms. CONCLUSIONS The prevalence of respiratory symptoms was high. Strong associations were found between respiratory symptoms and cardiovascular comorbidities. These are of particular importance given the extremely high level of cardiovascular disease mortality in Russia.
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Affiliation(s)
- Sarah Cook
- Department of Non Communicable Disease Epidemiology , London School of Hygiene & Tropical Medicine , London , UK
| | - Jennifer K Quint
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - David A Leon
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Arctic University of Norway, UiT, Tromsø, Norway
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Yang H, Xiang P, Zhang E, Guo W, Shi Y, Zhang S, Tong Z. Is hypercapnia associated with poor prognosis in chronic obstructive pulmonary disease? A long-term follow-up cohort study. BMJ Open 2015; 5:e008909. [PMID: 26671953 PMCID: PMC4679936 DOI: 10.1136/bmjopen-2015-008909] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess whether hypercapnia may predict the prognosis in chronic obstructive pulmonary disease (COPD). DESIGN Prospective cohort study comparing the survival of patients with COPD and normocapnia to those with chronic hypercapnia. SETTING Patients with consecutive COPD were enrolled between 1 May 1993 and 31 October 2006 at two medical centres. Follow-up was censored on 31 October 2011. PARTICIPANTS A total of 275 patients with stable COPD and aged 40-85 years were enrolled. Diagnosis of hypercapnia was confirmed by blood gas analysis. Patients with near-terminal illness or comorbidities that affect PaCO2 (obstructive sleep apnoea, obesity-related hypoventilation, or neuromuscular disease) were excluded. The outcome of 98 patients with normocapnia and 177 with chronic hypercapnia was analysed. OUTCOME MEASURES Overall survival. RESULTS Median survival was longer in patients with normocapnia than in those with hypercapnia (6.5 vs 5.0 years, p=0.016). Multivariate COX regression analysis indicated that age (HR=1.043, 95% CI 1.012 to 1.076), Charlson Index, which is a measure of comorbidity (HR=1.172, 95% CI 1.067 to 1.288), use of medication (HR=0.565, 95% CI 0.379 to 0.842), body mass index (BMI) (HR=0.922, 95% CI 0.883 to 0.963), PaCO2 (HR=1.026, 95% CI 1.011 to 1.042), Cor pulmonale (HR=2.164, 95% CI 1.557 to 3.006), non-invasive positive-pressure ventilation (NPPV) (HR=0.615, 95% CI 0.429 to 0.881) and per cent of forced expiratory volume in 1 s (FEV1%) (HR=0.979, 95% CI 0.967 to 0.991), were independent risk factors for mortality. CONCLUSIONS Increased age, Charlson Index, chronic hypercapnia and Cor pulmonale, and decreased FEV1%, use of medication, BMI and NPPV, were associated with a poor prognosis in patients with COPD.
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Affiliation(s)
- Hui Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital Beijing, Capital Medical University, Beijing, China
- Department of Respiratory and Critical Care Medicine, Shou-Gang Hospital Affiliated to Peking University, Beijing, China
| | - Pingchao Xiang
- Department of Respiratory and Critical Care Medicine, Shou-Gang Hospital Affiliated to Peking University, Beijing, China
| | - Erming Zhang
- Department of Respiratory and Critical Care Medicine, Shou-Gang Hospital Affiliated to Peking University, Beijing, China
| | - Weian Guo
- Department of Respiratory and Critical Care Medicine, Shou-Gang Hospital Affiliated to Peking University, Beijing, China
| | - Yanwei Shi
- Department of Respiratory and Critical Care Medicine, Shou-Gang Hospital Affiliated to Peking University, Beijing, China
| | - Shuo Zhang
- Department of Respiratory and Critical Care Medicine, Shou-Gang Hospital Affiliated to Peking University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital Beijing, Capital Medical University, Beijing, China
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Tiede SL, Gall H, Dörr O, Guilherme MDS, Troidl C, Liebetrau C, Voss S, Voswinckel R, Schermuly RT, Seeger W, Grimminger F, Zeiher AM, Dimmeler S, Möllmann H, Hamm CW, Ghofrani HA, Nef HM. New potential diagnostic biomarkers for pulmonary hypertension. Eur Respir J 2015; 46:1390-6. [DOI: 10.1183/13993003.00187-2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023]
Abstract
This study aimed to determine whether the vascular endothelial growth factor (VEGF) family members soluble VEGF receptor 1 (also called soluble fms-like tyrosine kinase 1 (sFlt-1)) and placental growth factor (PlGF) could be used as biomarkers for pulmonary hypertension (PH).Consecutive patients undergoing right heart catheterisation were enrolled (those with mean pulmonary arterial pressure ≥25 mmHg were classed as having PH; those with mean pulmonary arterial pressure <25 mmHg acted as non-PH controls). Plasma from the time of PH diagnosis was analysed for PlGF and sFlt-1 using enzyme immunoassays.In total, 247 patients with PH were enrolled: 62 with idiopathic pulmonary arterial hypertension (IPAH), 14 with associated pulmonary arterial hypertension (APAH), 21 with collagen vascular disease (CVD), 26 with pulmonary venous hypertension, 67 with lung disease-associated PH and 57 with chronic thromboembolic PH. The non-PH control group consisted of 40 patients. sFlt-1 plasma levels were significantly higher in patients with IPAH, APAH, CVD and lung disease-associated PH versus controls; PlGF levels were significantly higher in all PH groups versus controls. The combination of sFlt-1 and PlGF resulted in a sensitivity of 83.7% with specificity of 100% for pulmonary arterial hypertension. There was no association between sFlt-1 or PlGF and haemodynamic parameters, 6-min walking distance or survival.In summary, PlGF and sFlt-1 are promising diagnostic biomarkers for PH.
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Park SY, Lee CY, Kim C, Jang SH, Park YB, Park S, Hwang YI, Lee MG, Jung KS, Kim DG. One-year prognosis and the role of brain natriuretic peptide levels in patients with chronic cor pulmonale. J Korean Med Sci 2015; 30:442-9. [PMID: 25829812 PMCID: PMC4366965 DOI: 10.3346/jkms.2015.30.4.442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/27/2014] [Indexed: 11/20/2022] Open
Abstract
Data on the clinical outcomes and role of brain natriuretic peptide (BNP) levels in patients with chronic cor pulmonale are limited. A total of 69 patients with chronic cor pulmonale, admitted for dyspnea (January 2007 to September 2011) to three university hospitals, were retrospectively reviewed. All of the patients had right ventricular (RV) dysfunction on echocardiography. The median age was 70.0 yr, and chronic obstructive pulmonary disease (40.6%) and tuberculosis-destroyed lung (TDL, 27.5%) were the leading causes of chronic cor pulmonale. At the 1-yr follow-up, the mortality rate was 15.9%, and the readmission rate was 53.7%; patients with TDL had higher mortality (31.6% vs. 10.0%; P=0.059) and readmission rates (78.9% vs. 43.8%; P=0.009) than those with non-TDL diseases. The area under the receiver operating characteristic curve for admission BNP levels to predict readmission was 0.788 (95% confidence interval [CI], 0.673-0.904), and the sensitivity and specificity of the cut-off value were 80.6% and 77.4%, respectively. In multivariate analysis, high admission BNP levels were a significant risk factor for subsequent readmission (hazard ratio, 1.049; 95% CI, 1.005-1.094). Additionally, admission BNP levels were well correlated with cardiac troponin I (r=0.558), and delta BNP also correlated with delta RV systolic pressure (n=25; r=0.562). In conclusion, among hospitalized patients with chronic cor pulmonale, admission high BNP levels are a significant risk factor for subsequent readmission. Therefore, more intensive monitoring and treatment are needed in patients with higher BNP levels.
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Affiliation(s)
- So Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chang Youl Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Changhwan Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Myung Goo Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong-Gyu Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
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Huang YS, Feng YC, Zhang J, Bai L, Huang W, Li M, Sun Y. Impact of chronic obstructive pulmonary diseases on left ventricular diastolic function in hospitalized elderly patients. Clin Interv Aging 2014; 10:81-7. [PMID: 25565790 PMCID: PMC4279668 DOI: 10.2147/cia.s71878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the impact of chronic obstructive pulmonary disease (COPD) on left ventricular (LV) diastolic function in hospitalized elderly patients. Methods This was a case–control observational study of 148 consecutive hospitalized elderly patients (≥65 years old): 73 subjects without COPD as controls and 75 patients with COPD. Mild-to-moderate COPD was defined as stages 1 and 2, while severe and very severe COPD was defined as stages 3 and 4, according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. Clinical characteristics and echocardiographic parameters were analyzed and compared. Results Compared with the control group, patients with COPD had a higher frequency of LV diastolic dysfunction and heart failure with preserved ejection fraction. Smoking frequency, frequency of cerebrovascular diseases and diabetes, and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were higher in the COPD group (all P<0.05). COPD patients showed more abnormalities in diastolic function (E/e′: 11.51±2.50 vs 10.42±3.25, P=0.047), but no differences in systolic function and right ventricular function (all P>0.05). Patients with severe/very severe COPD showed no differences in LV diastolic function compared to patients with mild/moderate COPD (P>0.05), but serum NT-proBNP levels were higher in severe/very severe COPD (P<0.05). Conclusion Results suggest that early-stage COPD may have an impact on the LV diastolic function. Severe COPD mainly affected right ventricular function. In hospitalized elderly patients with COPD, LV diastolic dysfunction should be taken into account together with right ventricular function.
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Affiliation(s)
- Ying-Shuo Huang
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ying-Chao Feng
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jian Zhang
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li Bai
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Huang
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Min Li
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ying Sun
- Department of Geriatrics and Gerontology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Nayer J, Aggarwal P, Galwankar S. Utility of point-of-care testing of natriuretic peptides (brain natriuretic peptide and n-terminal pro-brain natriuretic peptide) in the emergency department. Int J Crit Illn Inj Sci 2014; 4:209-15. [PMID: 25337482 PMCID: PMC4200546 DOI: 10.4103/2229-5151.141406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rapid and accurate diagnosis of a patient with an acute disease is a challenge for emergency physicians. Natriuretic peptides have emerged as important tools for diagnosis, risk stratification and therapeutic decision making for some categories of emergency patients. Brain natriuretic peptide (BNP) is a member of a four natriuretic peptides family that shares a common 17-peptide ring structure. Atrial natriuretic peptide, C-natriuretic peptide (CNP), and D-type natriuretic peptide are the other natriuretic peptide, which share the same common 17-peptide ring structure. The N-terminal fragment of pro-BNP, N-terminal pro-brain natriuretic peptide (NT-proBNP) consists of 76 amino acids, which is biologically inert, while the active component BNP contains 32 amino acids. BNP and NT-proBNP are secreted in the plasma in equimolar quantities and are frequently used in the diagnosis of congestive heart failure, and distinguishing between patients with dyspnea of cardiac or pulmonary origin. Both natriuretic peptides have also been evaluated for use in the assessment and management of several other conditions including sepsis, cirrhosis of liver and renal failure. However, one should remember that the values of natriuretic peptides are affected by age and weight of the patients, and presence of several comorbidities such as chronic renal failure, type 2 diabetes mellitus, anemia, pulmonary embolism, and acute coronary syndrome. Values of these peptides also vary depending on the type of test used. The performance characteristics of these natriuretic peptides vary depending on the patients on whom they are used. Therefore determination of reference values for these peptides represents a challenge.
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Affiliation(s)
- Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of South Florida and Winter Haven Hospital, Florida, USA
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26
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Faludi R. [Chronic obstructive pulmonary disease: a cardiologist's point of view]. Orv Hetil 2014; 155:1480-4. [PMID: 25194870 DOI: 10.1556/oh.2014.29989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic obstructive pulmonary disease is often associated with cardiovascular diseases, such as pulmonary hypertension, ischemic heart disease, arrhythmias or heart failure. These co-morbidities may cause diagnostic or therapeutic difficulties and significantly worsen the morbidity and mortality of patients with chronic obstructive pulmonary disease. In this work the author reviews special considerations for the treatment of patients with chronic obstructive pulmonary disease who have cardiovascular co-morbidities.
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Affiliation(s)
- Réka Faludi
- Pécsi Tudományegyetem Szívgyógyászati Klinika Pécs Ifjúság u. 13. 7624
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27
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Minai OA. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Biomarkers in pulmonary arterial hypertension. Ann Thorac Med 2014; 9:S92-7. [PMID: 25077003 PMCID: PMC4114275 DOI: 10.4103/1817-1737.134047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/05/2014] [Indexed: 12/22/2022] Open
Abstract
The biomarker is an indicaror of a biological or pathological process. Clinical observations, measures or environmental events, or measured laboratory values can all be biomarkers in the appropriate setting. An ideal biomarker reflects the underlying biological process, predicts clinical events, is easily obtainable, is reproducible and is not prohibitively expensive. This typically requires validation in longitudinal cohort studies. Biomarkers may help understand the pathological mechanisms responsible for the disease, help as screening tools, predict disease worsening or decline, and determine adequacy of response to therapeutic interventions.
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Affiliation(s)
- Omar A Minai
- Associate Professor of Medicine, Respiratory Institute, Cleveland Clinic, Ohio, USA
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Flessas N, Alexanian I, Parissis J, Kremastinos D, Lekakis J, Filippatos G. Plasma activity of B-type natriuretic peptide in patients with biventricular heart failure versus those with right heart failure due to chronic obstructive pulmonary disease. J Cardiovasc Med (Hagerstown) 2014; 15:476-80. [DOI: 10.2459/jcm.0000000000000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Nishimura K, Nishimura T, Onishi K, Oga T, Hasegawa Y, Jones PW. Changes in plasma levels of B-type natriuretic peptide with acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:155-62. [PMID: 24523584 PMCID: PMC3921082 DOI: 10.2147/copd.s55143] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Elevated plasma B-type natriuretic peptide (BNP) levels and their association with heart failure have been reported in subjects with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Purpose To examine and compare plasma BNP levels and diastolic and systolic dysfunction in subjects with AECOPD and stable chronic obstructive pulmonary disease (COPD). Methods In all, 87 unselected consecutive hospitalizations due to AECOPD in 61 subjects and a total of 190 consecutive subjects with stable COPD were recruited. Plasma BNP levels were compared cross-sectionally and longitudinally. Transthoracic echocardiographic examinations were also performed in the hospitalized subjects. Results In the hospitalized subjects, the median plasma BNP level (interquartile range) was 55.4 (26.9–129.3) pg/mL and was higher than that of patients with stable COPD: 18.3 (10.0–45.3) for Global Initiative for Chronic Obstructive Lung Disease grade I; 25.8 (11.0–53.7) for grade II; 22.1 (9.1–52.6) for grade III; and 17.2 (9.6–22.9) pg/mL for grade I V, all P<0.001. In 15 subjects studied prospectively, the median plasma BNP level was 19.4 (9.8–32.2) pg/mL before AECOPD, 72.7 (27.7–146.3) pg/mL during AECOPD, and 14.6 (12.9–39.0) pg/mL after AECOPD (P<0.0033 and P<0.0013, respectively). Median plasma BNP levels during AECOPD were significantly higher in ten unsuccessfully discharged subjects 260.5 (59.4–555.0) than in 48 successfully discharged subjects 48.5 (24.2–104.0) pg/mL (P=0.0066). Only 5.6% of AECOPD subjects were associated with systolic dysfunction defined as a left ventricular ejection fraction (LVEF) <50%; a further 7.4% were considered to have impaired relaxation defined as an E/A wave velocity ratio <0.8 and a deceleration time of E >240 ms. BNP levels were weakly correlated with the E/peak early diastolic velocity of the mitral annulus (Ea) ratio (Spearman’s rank correlation coefficient =0.353, P=0.018), but they were not correlated with the LVEF (Spearman’s rank correlation coefficient =−0.221, P=0.108). Conclusion A modest elevation of plasma BNP is observed during AECOPD. It appears that AECOPD may have an impact on plasma BNP levels that is not attributable to heart failure.
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Affiliation(s)
- Koichi Nishimura
- Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | | | | | - Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinori Hasegawa
- Division of Respiratory Medicine, Department of Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Paul W Jones
- Division of Clinical Science, St George's Hospital Medical School, London, England
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Role of N-terminal pro B-type natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kaplan A, Gruffydd-Jones K, van Gemert F, Kirenga BJ, Medford ARL. A woman with breathlessness: a practical approach to diagnosis and management. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:468-76. [PMID: 24270362 PMCID: PMC6442845 DOI: 10.4104/pcrj.2013.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/26/2013] [Indexed: 02/05/2023]
Abstract
Worsening breathless in a patient with severe chronic obstructive pulmonary disease (COPD) is a common diagnostic and management challenge in primary care. A systematic approach to history-taking and examination combined with targeted investigation of pulmonary, cardiovascular, thromboembolic and systemic causes is essential if co-morbidities are to be identified and managed. Distinguishing between heart failure and COPD is a particular challenge as symptoms and signs overlap. In low and middle income countries additional priorities are the detection of infections such as tuberculosis and human immunodeficiency virus (HIV). Clinicians need to be alert to the possibility of atypical presentations (such as pain-free variants of angina) and less common conditions (including chronic thromboembolic pulmonary hypertension) in order not to overlook important potentially treatable conditions.
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Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, Richmond Hill, Ontario, Canada
| | | | - Frederik van Gemert
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce J Kirenga
- Department of Medicine, School of Medicine, Makerere University, Kampala, Uganda
| | - Andrew RL Medford
- Consultant & Honorary Senior Lecturer in Thoracic Medicine & Interventional Pulmonology, North Bristol Lung Centre & University of Bristol, Southmead Hospital, Bristol, UK
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Hawkins NM, Virani S, Ceconi C. Heart failure and chronic obstructive pulmonary disease: the challenges facing physicians and health services. Eur Heart J 2013; 34:2795-803. [PMID: 23832490 DOI: 10.1093/eurheartj/eht192] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pulmonary disease is common in patients with heart failure, through shared risk factors and pathophysiological mechanisms. Adverse pulmonary vascular remodelling and chronic systemic inflammation characterize both diseases. Concurrent chronic obstructive pulmonary disease presents diagnostic and therapeutic challenges, and is associated with increased morbidity and mortality. The cornerstones of therapy are beta-blockers and beta-agonists, whose pharmacological properties are diametrically opposed. Each disease is implicated in exacerbations of the other condition, greatly increasing hospitalizations and associated health care costs. Such multimorbidity is a key challenge for health-care systems oriented towards the treatment of individual diseases. Early identification and treatment of cardiopulmonary disease may alleviate this burden. However, diagnostic and therapeutic strategies require further validation in patients with both conditions.
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Affiliation(s)
- Nathaniel M Hawkins
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
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Hassoun PM, Nikkho S, Rosenzweig EB, Moreschi G, Lawrence J, Teeter J, Meier C, Ghofrani AH, Minai O, Rinaldi P, Michelakis E, Oudiz RJ. Updating clinical endpoint definitions. Pulm Circ 2013; 3:206-16. [PMID: 23662199 PMCID: PMC3641732 DOI: 10.4103/2045-8932.109920] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The 6-Minute Walk Distance (6-MWD) has been the most utilized endpoint for judging the efficacy of pulmonary arterial hypertension (PAH) therapy in clinical trials conducted over the past two decades. Despite its simplicity, widespread use in recent trials and overall prognostic value, the 6-MWD has often been criticized over the past several years and pleas from several PAH experts have emerged from the literature to find alternative endpoints that would be more reliable in reflecting the pulmonary vascular resistance as well as cardiac status in PAH and their response to therapy. A meeting of PAH experts and representatives from regulatory agencies and pharmaceutical companies was convened in early 2012 to discuss the validity of current as well as emerging valuable endpoints. The current work represents the proceedings of the conference.
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Kaszuba E, Wagner B, Odeberg H, Halling A. Using NT-proBNP to Detect Chronic Heart Failure in Elderly Patients with Chronic Obstructive Pulmonary Disease. ISRN FAMILY MEDICINE 2013; 2013:273864. [PMID: 24967321 PMCID: PMC4041248 DOI: 10.5402/2013/273864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/28/2013] [Indexed: 11/23/2022]
Abstract
Objective. To detect chronic heart failure in elderly patients with a registered diagnosis of chronic obstructive pulmonary disease (COPD) treated in Swedish primary health care using natriuretic peptide NT-proBNP. Design. A cross-sectional study. Setting. Two primary health care centres in southeastern Sweden each with about 9000 listed patients.
Subjects. Patients aged 65 years and older with a registered diagnosis of COPD. Main Outcome Measures. Percentage of patients with elevated NT-proBNP, percentage of patients with abnormal left ventricular function assessed by echocardiography, and association between elevated NT-proBNP and symptoms, signs, and electrocardiography. Results. Using NT-proBNP threshold of 1200 pg/mL, we could detect and confirm chronic heart failure in 5.6% of the study population with concurrent COPD. An elevated level of NT-proBNP was only associated with nocturia and abnormal electrocardiography. Conclusions. We found considerably fewer cases of heart failure in patients with COPD than could be expected from the results of previous studies. Our study shows the need for developing improved strategies to enhance the validity of a suspected heart failure diagnosis in patients with COPD.
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Affiliation(s)
- Elzbieta Kaszuba
- Blekinge Competence Centre, Wämö Centre, 371 81 Karlskrona, Sweden ; Lund University, Department of Clinical Sciences in Malmö, General Practice/Family Medicine, 205 02 Malmö, Sweden
| | | | - Håkan Odeberg
- Blekinge Competence Centre, Wämö Centre, 371 81 Karlskrona, Sweden ; Lund University, Department of Clinical Sciences in Malmö, General Practice/Family Medicine, 205 02 Malmö, Sweden
| | - Anders Halling
- Blekinge Competence Centre, Wämö Centre, 371 81 Karlskrona, Sweden ; Lund University, Department of Clinical Sciences in Malmö, General Practice/Family Medicine, 205 02 Malmö, Sweden ; Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, 5000 Odense C, Denmark
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Abstract
The development of pulmonary hypertension in COPD adversely affects survival and exercise capacity and is associated with an increased risk of severe acute exacerbations. Unfortunately not all patients with COPD who meet criteria for long term oxygen therapy benefit from it. Even in those who benefit from long term oxygen therapy, such therapy may reverse the elevated pulmonary artery pressure but cannot normalize it. Moreover, the recent discovery of the key roles of endothelial dysfunction and inflammation in the pathogenesis of PH provides the rationale for considering specific pulmonary vasodilators that also possess antiproliferative properties and statins.
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Mentz RJ, Fiuzat M, Kraft M, Lindenfeld J, O’Connor CM. Bronchodilators in Heart Failure Patients With COPD: Is It Time for a Clinical Trial? J Card Fail 2012; 18:413-22. [DOI: 10.1016/j.cardfail.2012.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 12/22/2022]
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Masugata H, Senda S, Okada H, Murao K, Inukai M, Himoto T, Hosomi N, Murakami K, Noma T, Kohno M, Goda F. Association between Cardiac Function and Pulmonary Function in Hypertensive Patients. J Int Med Res 2012; 40:105-14. [DOI: 10.1177/147323001204000111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: This study examined the association between cardiac function and pulmonary function in hypertensive patients. METHODS: Hypertensive patients without overt cardiovascular disease were enrolled ( n = 43; mean ± SD age 71 ± 9 years). Pulmonary function was measured by the percentage of predicted forced vital capacity (%FVC) and the ratio of 1 s forced expiratory volume (FEV1) to FVC (FEV1/FVC ratio). Left ventricular ejection fraction (LVEF) and the ratio of peak early diastolic transmitral flow (E) to peak early diastolic mitral annular velocity (e′) (E/e′ ratio) were assessed using echocardiography. RESULTS: Multiple linear regression analysis revealed that E/e′ was independently associated with %FVC and that LVEF was independently associated with FEV1/FVC ratio. Both LVEF and FEV1/FVC ratio were significantly lower in hypertensive former or current smokers than in hypertensive never smokers. CONCLUSIONS: Subclinical cardiac dysfunction was independently associated with reduced pulmonary function in hypertensive patients. Hypertensive patients with decreased pulmonary function may need preventive care to prevent the progression of heart failure.
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Affiliation(s)
- H Masugata
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | - S Senda
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | - H Okada
- Department of Medical Education, Kagawa University, Kagawa, Japan
| | - K Murao
- Department of Advanced Medicine and Laboratory Medicine, Kagawa University, Kagawa, Japan
| | - M Inukai
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | - T Himoto
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | - N Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - K Murakami
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - T Noma
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - M Kohno
- Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, Japan
| | - F Goda
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
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Gale CP, White JES, Hunter A, Owen J, Allen J, Watson J, Holbrook I, Durham NP, Pye MP. Predicting mortality and hospital admission in patients with COPD: significance of NT pro-BNP, clinical and echocardiographic assessment. J Cardiovasc Med (Hagerstown) 2011; 12:613-8. [PMID: 21792022 DOI: 10.2459/jcm.0b013e3283491780] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To quantify the ability of N-terminal pro-brain natriuretic peptide (NT pro-BNP) to predict mortality and hospitalization in patients with chronic obstructive airways disease (COPD). METHODS Prospective single-centre observational study of 140 consecutive patients aged at least 18 years with COPD between 27 March 2004 and 28 February 2008 (median follow-up 3.9 years). RESULTS Sixty-five (46%) men, 26 (19%) O2 therapy, 115 (82%) smokers, 38 (27%) patients receiving diuretics, 15 (11%) left-ventricular ejection fraction less than 45%. Median [interquartile range (IQR)] NT pro-BNP concentration 16.2 (25.4) pmol/l. NT pro-BNP was higher in those with a dilated left atrium (P<0.001), aortic stenosis (P=0.02), left-ventricular systolic dysfunction (P=0.027), right ventricular impairment (P=0.011), atrial fibrillation (P<0.001), patients receiving diuretics (P=0.010) and angiotensin-converting enzyme (ACE) inhibitors (P=0.006). One-year mortality and hospitalization rates were 2.9 and 25.4%. The median (IQR) time to hospitalization and length of first hospital stay: 383.5 (605) and 4.0 (7.0) days. NT pro-BNP was an excellent discriminator of right-ventricular impairment (C statistic=0.90) and predicted survival (highest quartile versus lowest quartile relative risk=3.02, P=0.001), but not hospital admission. After adjustment this association was not significant. CONCLUSION NT pro-BNP predicts survival, but not hospital admission in patients with COPD. The ability of NT pro-BNP to independently predict death or hospitalization is superseded by the presence of a dilated left atrium, aortic stenosis and left-ventricular systolic dysfunction.
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Affiliation(s)
- Chris P Gale
- Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
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Yilmaz MB, Zorlu A, Dogan OT, Karahan O, Tandogan I, Akkurt I. Role of CA-125 in identification of right ventricular failure in chronic obstructive pulmonary disease. Clin Cardiol 2011; 34:244-8. [PMID: 21404303 DOI: 10.1002/clc.20868] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 10/28/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating disease. Cor pulmonale, characterized by right ventricular (RV) failure, can severely influence prognosis in these patients. Hence, early recognition might be important for tailoring therapy. An old biomarker, CA-125, seems to be associated with the right heart. We aimed to show the relationship between CA-125 levels and RV failure in patients with COPD. HYPOTHESIS CA-125 might be a useful biomarker in identification of RV failure in patients with COPD. METHODS Forty patients with recent exacerbation of COPD were enrolled into the study. Another 40 age- and sex-matched individuals were enrolled for comparison. Levels of CA-125 were measured in the patients during the hospital stay. The COPD patients underwent echocardiographic study on the same day. Right-ventricular parameters were evaluated, and RV failure was identified via transthoracic echocardiography. RESULTS Patients with COPD had significantly higher CA-125 levels compared with controls (median 33.94 U/mL vs 9.76 U/mL, respectively; P < 0.001). Levels of CA-125 were correlated with systolic pulmonary artery pressure (r = 0.550, P < 0.001), tricuspid annular plane systolic excursion (r = - 0.496, P = 0.001), and tricuspid lateral annulus S velocity (r = - 0.549, P = 0.002). High CA-125 levels, obtained in hospitalized patients with COPD before echocardiography, enabled identification of RV failure with a sensitivity of 89.5% and specificity of 85.7%. CONCLUSIONS The CA-125 biomarker can be used to identify COPD patients with RV failure.
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Affiliation(s)
- Mehmet Birhan Yilmaz
- Department of Cardiology, Department of Cardiovascular Surgery, Cumhuriyet University School of Medicine, Sivas, Turkey.
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BPCO e scompenso cardiaco. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Villa A, Marino P, Kostihova A. Subclinical right ventricular dysfunction in patients with COPD. Respir Med 2010; 104:1951-2. [PMID: 20888209 DOI: 10.1016/j.rmed.2010.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/01/2010] [Accepted: 09/09/2010] [Indexed: 10/19/2022]
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van Gestel YRBM, Goei D, Hoeks SE, Sin DD, Flu WJ, Stam H, Mertens FW, Bax JJ, van Domburg RT, Poldermans D. Predictive Value of NT-proBNP in Vascular Surgery Patients with COPD and Normal Left Ventricular Systolic Function. COPD 2010; 7:70-5. [DOI: 10.3109/15412550903499472] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Despite recent advances in medical treatment, pulmonary arterial hypertension (PAH) continues to be associated with high morbidity and mortality. While the diagnosis is established via a right heart catheterisation, current non-invasive measures of disease severity and response to treatment used in clinical practice are the 6-min walk distance and the World Health Organization functional class. Although both parameters correlate with disease severity and prognosis, they have significant limitations. A major shortcoming in assessing PAH is lack of standardised, non-invasive, objective parameters that function as biomarkers to help assess the severity and prognosis of disease and to follow patients' response to treatment. In this article, we will review current knowledge on potential biomarkers associated with diagnosis, prognosis and response to treatment of PAH. Most biomarkers are either being evaluated for potential use in clinical practice, or being used as research tools.
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Affiliation(s)
- S Rafeq
- Pulmonary, Critical Care and Sleep Division, Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02111, USA
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Papaioannou AI, Mazioti A, Kiropoulos T, Tsilioni I, Koutsokera A, Tanou K, Nikoulis DJ, Georgoulias P, Zakynthinos E, Gourgoulianis KI, Kostikas K. Systemic and airway inflammation and the presence of emphysema in patients with COPD. Respir Med 2009; 104:275-82. [PMID: 19854037 DOI: 10.1016/j.rmed.2009.09.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 09/04/2009] [Accepted: 09/11/2009] [Indexed: 01/10/2023]
Abstract
The aim of this study was to determine the impact of HRCT-confirmed emphysema on biomarkers evaluating airway and systemic inflammation in COPD patients. Forty-nine consecutive male COPD outpatients with stable COPD were divided in two groups according to the presence or absence of emphysema on HRCT. Patients underwent pulmonary function tests, plus assessment of exercise capacity, body composition and quality of life. Biomarkers were measured in serum (CRP, interleukin-6, TNF-alpha, leptin, adiponectin, osteocalcin, insulin growth factor-1, and systemic oxidative stress), in plasma (fibrinogen and VEGF) and in whole blood (B-type natriuretic peptide). TNF-alpha, 8-isoprostane and pH were additionally measured in exhaled breath condensate. Patients with emphysema had more severe lung function impairment, lower body-mass index and fat-free mass index, and poorer quality of life. Additionally, they presented increased systemic oxidative stress and plasma fibrinogen and lower BNP compared to patients without emphysema. After proper adjustment for disease severity, all differences remained with the exceptions of body-mass index, fat-free mass index and BNP. COPD patients with HRCT-confirmed emphysema present increased systemic oxidative stress and fibrinogen, suggesting that they may be more prone to the systemic consequences of COPD compared to patients without emphysema.
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Jyothula S, Safdar Z. Update on pulmonary hypertension complicating chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2009; 4:351-63. [PMID: 19802350 PMCID: PMC2754087 DOI: 10.2147/copd.s5102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Indexed: 12/04/2022] Open
Abstract
Pulmonary hypertension (PH) is the hemodynamic manifestation of various pathological processes that result in elevated pulmonary artery pressures (PAP). The National Institutes of Health Registry defined pulmonary arterial hypertension as the mean PAP of more than 25 mm Hg with a pulmonary capillary wedge pressure or left atrial pressure equal to or less than 15 mm Hg. This definition remains the currently accepted definition of PH that is used to define PH related to multiple clinical conditions including chronic obstructive pulmonary disease (COPD). The estimated US prevalence of COPD by the National Health Survey in 2002 in people aged >25 was 12.1 million. There is a lack of large population-based studies in COPD to document the correct prevalence of PH and outcome. The major cause of PH in COPD is hypoxemia leading to vascular remodeling. Echocardiogram is the initial screening tool of choice for PH. This simple noninvasive test can provide an estimate of right ventricular systolic and right atrial pressures. Right heart catheterization remains the gold standard to diagnose PH. It provides accurate measurement of mean PAP and pulmonary capillary wedge pressure. Oxygen therapy remains the cornerstone therapeutic for hypoxemia in COPD patients. Anecdotal reports suggest utility of PDE5-inhibitors and prostacyclin to treat COPD-related PH. Large randomized clinical trials are needed before the use of these drugs can be recommended.
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Affiliation(s)
- Soma Jyothula
- Pulmonary-Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Connolly DJ, Soares Magalhaes RJ, Fuentes VL, Boswood A, Cole G, Boag A, Syme HM. Assessment of the diagnostic accuracy of circulating natriuretic peptide concentrations to distinguish between cats with cardiac and non-cardiac causes of respiratory distress. J Vet Cardiol 2009; 11 Suppl 1:S41-50. [PMID: 19394286 DOI: 10.1016/j.jvc.2009.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine if serum natriuretic peptide (NP) concentrations could distinguish cardiac from non-cardiac causes of respiratory distress (RD) in cats. ANIMALS Seventy-four cats from 1 university hospital were used. METHODS Serum NP concentrations were measured in 41 cats with non-cardiac respiratory distress (RD-NC) and compared to 33 cats with RD due to congestive heart failure (RD+CHF) using sandwich enzyme immunoassays (ELISA). RESULTS RD-NC cats had lower (P=0.0001) median NT-proANP and NT-proBNP concentrations (614 and 45 fmol/mL, respectively) than RD+CHF cats (1690 and 523 fmol/mL, respectively). The area under the curve was 0.88 and 0.96 for the receiver operating curve analysis of the diagnostic accuracy of NT-proANP and NT-proBNP concentrations to discriminate RD+CHF from RD-NC cats (P=0.036). An optimum cut-off concentration of 986 fmol/mL for NT-proANP and 220 fmol/mL for NT-proBNP accurately discriminated RD-NC from RC+CHF cats with a sensitivity of 93.8% and 93.9% and a specificity of 80.3% and 87.8%, respectively. CONCLUSIONS Serum NP concentrations were different in RD+CHF cats compared to RD-NC cats. Evaluation of circulating NP concentrations may be helpful in the initial approach to cats presenting with respiratory distress, particularly if advances in ELISA technology result in a rapid cage-side test.
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Affiliation(s)
- David J Connolly
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK.
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Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009; 11:130-9. [PMID: 19168510 PMCID: PMC2639415 DOI: 10.1093/eurjhf/hfn013] [Citation(s) in RCA: 378] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 08/31/2008] [Accepted: 11/03/2008] [Indexed: 11/12/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are global epidemics incurring significant morbidity and mortality. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. Evaluation of cardiac and pulmonary function is often problematic and occasionally misleading. Echocardiography and pulmonary function tests should be performed in every patient. Careful interpretation is required to avoid misdiagnosis and inappropriate treatment. Airflow obstruction, in particular, must be demonstrated when clinically euvolaemic. Very high and very low concentrations of natriuretic peptides have high positive and negative predictive values for diagnosing HF in those with both conditions. Intermediate values are less informative. Both conditions are systemic disorders with overlapping pathophysiological processes. In patients with HF, COPD is consistently an independent predictor of death and hospitalization. However, the impact on ischaemic and arrhythmic events is unknown. Greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone.
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Affiliation(s)
- Nathaniel Mark Hawkins
- Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
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Barents M, Hillege HH, van der Horst IC, de Boer RA, Koster J, Muskiet FA, de Jongste MJ. BNP and NT-proBNP, Predictors of 1-Year Mortality in Nursing Home Residents. J Am Med Dir Assoc 2008; 9:580-5. [DOI: 10.1016/j.jamda.2008.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 05/15/2008] [Accepted: 05/21/2008] [Indexed: 11/28/2022]
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Detection of acute heart failure in chronic obstructive pulmonary disease patients: role of B-type natriuretic peptide. Curr Opin Crit Care 2008; 14:340-7. [PMID: 18467897 DOI: 10.1097/mcc.0b013e3282faa304] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Unrecognized chronic heart failure is present in 21-30% of chronic obstructive pulmonary disease patients. It may be a precipitating factor for acute exacerbation of chronic obstructive pulmonary disease or may hinder weaning from mechanical ventilation. The aim of the review is to emphasize recent studies that validated measurements of plasma B-type natriuretic peptide in the diagnosis of heart dysfunction in chronic obstructive pulmonary disease patients. RECENT FINDINGS Measurements of B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptides are accurate in the diagnosis of left heart dysfunction in chronic obstructive pulmonary disease patients either in stable condition or during acute exacerbation of chronic obstructive pulmonary disease. Natriuretic peptide thresholds are elevated in comparison to cut-offs usually reported in patients without pulmonary disease. B-type natriuretic peptide dosage is also able to uncover new onset of left heart failure associated with weaning difficulties from mechanical ventilation in chronic obstructive pulmonary disease patients. SUMMARY Recent evidence suggests that natriuretic peptide measurements are accurate in the diagnosis of coexisting left heart failure in chronic obstructive pulmonary disease patients, either in stable condition or during severe cardiopulmonary interactions occurring during acute exacerbation of chronic obstructive pulmonary disease, or evoking weaning difficulties related to left heart dysfunction.
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Villar Álvarez F, de Miguel Díez J, Luis Álvarez-Sala J. EPOC y acontecimientos cardiovasculares. Arch Bronconeumol 2008. [DOI: 10.1157/13116603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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