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Bhat R, Kamath S, Jain A, Acharya V, Antony T, Holla R, Jha A. RV in COPD - The complicated matters of the heart - Correlation of ECHO and biomarker with COPD severity and outcome. Lung India 2024; 41:192-199. [PMID: 38687230 PMCID: PMC11093146 DOI: 10.4103/lungindia.lungindia_351_23] [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: 07/10/2023] [Revised: 01/19/2024] [Accepted: 02/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular involvement, which is among the leading causes of morbidity and mortality worldwide. Echocardiography (ECHO) could be a reliable, non-invasive tool for predicting the risk of cardiovascular modalities in patients with COPD. Combining the ECHO parameters with highly selective cardiac troponin could predict the severity and outcome of patients with COPD. METHODS This prospective observational study was conducted at a tertiary care hospital in South India. All patients who met the criteria were included. Patients with other concomitant chronic lung diseases were excluded. An echocardiographic examination was performed, and blood samples for hs-Tnt were taken on admission for patients admitted with COPD. Categorical variables were analyzed using Pearson's Chi-square test, and the T-test was used to compare the means. One-way analysis of variance (ANOVA) followed by the Bonferroni multiple comparison tests was done to compare different echo parameters concerning COPD severity. RESULTS The mean tricuspid annulus plane systolic excursion (TAPSE) and right ventricle (RV) fraction area change (FAC) values were lower with the increase in the disease severity (P < 0.001). There was a significant increase in the mean systolic pressures in the right atrium and ventricle in patients with severe COPD (P < 0.001). The mean hs-TnT values were significantly higher in patients with severe COPD (18.86 ± 18.12) and correlated well with the increase in the severity of the disease (P < 0.001). Changes in the echo parameters, such as mean TAPSE and RV FAC values, negatively correlated with COPD severity. There was an increase in systolic pressure in both atria and ventricles with the progression of COPD. Troponin helped predict mortality during hospitalization. CONCLUSION Comprehensive echocardiographic parameters, such as TAPSE and RV FAC, help assess the disease's severity, predict mortality, and evaluate whether the proper ventricular function is reliable. Troponin is a valuable adjunct that is an independent and strong predictor of overall mortality in patients with COPD.
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Affiliation(s)
- Rajesh Bhat
- Department of Cardiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sindhu Kamath
- Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arpit Jain
- Consultant Cardiologist, Adiyogi Hospital, Dewas, Madhya Pradesh, India
| | - Vishak Acharya
- Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Thomas Antony
- Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhavya Jha
- Junior Resident, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Celeski M, Segreti A, Polito D, Valente D, Vicchio L, Di Gioia G, Ussia GP, Incalzi RA, Grigioni F. Traditional and Advanced Echocardiographic Evaluation in Chronic Obstructive Pulmonary Disease: The Forgotten Relation. Am J Cardiol 2024; 217:102-118. [PMID: 38412881 DOI: 10.1016/j.amjcard.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a significant preventable and treatable clinical disorder defined by a persistent, typically progressive airflow obstruction. This disease has a significant negative impact on mortality and morbidity worldwide. However, the complex interaction between the heart and lungs is usually underestimated, necessitating more attention to improve clinical outcomes and prognosis. Indeed, COPD significantly impacts ventricular function, right and left chamber architecture, tricuspid valve functionality, and pulmonary blood vessels. Accordingly, more emphasis should be paid to their diagnosis since cardiac alterations may occur very early before COPD progresses and generate pulmonary hypertension (PH). Echocardiography enables a quick, noninvasive, portable, and accurate assessment of such changes. Indeed, recent advancements in imaging technology have improved the characterization of the heart chambers and made it possible to investigate the association between a few cardiac function indexes and clinical and functional aspects of COPD. This review aims to describe the intricate relation between COPD and heart changes and provide basic and advanced echocardiographic methods to detect early right ventricular and left ventricular morphologic alterations and early systolic and diastolic dysfunction. In addition, it is crucial to comprehend the clinical and prognostic significance of functional tricuspid regurgitation in COPD and PH and the currently available transcatheter therapeutic approaches for its treatment. Moreover, it is also essential to assess noninvasively PH and pulmonary resistance in patients with COPD by applying new echocardiographic parameters. In conclusion, echocardiography should be used more frequently in assessing patients with COPD because it may aid in discovering previously unrecognized heart abnormalities and selecting the most appropriate treatment to improve the patient's symptoms, quality of life, and survival.
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Affiliation(s)
- Mihail Celeski
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Andrea Segreti
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
| | - Dajana Polito
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Daniele Valente
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Luisa Vicchio
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Giuseppe Di Gioia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | | | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
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Mohammed RA, Mohamed LA, Abdelsalam EM, Maghraby HM, Elkenany NM, Nabawi OE, Sultan I. Assessment of Cardiac Dysfunction in Patients With Chronic Obstructive Pulmonary Disease (COPD): A Cross-Sectional Study. Cureus 2023; 15:e39629. [PMID: 37388620 PMCID: PMC10303266 DOI: 10.7759/cureus.39629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are frequent in patients having chronic obstructive pulmonary disease (COPD). Despite that, comorbid CVDs receive less guideline-recommended screening in this population compared to others. We aimed to evaluate the cardiac function using echocardiography and to assess spirometry, arterial blood gas (ABG) as well as brain natriuretic peptide (BNP) as prognostic indicators of cardiovascular dysfunction in COPD patients. METHODS One hundred moderate to very severe COPD patients according to GOLD guidelines with no history of cardiac diseases were recruited from two hospitals in Saudi Arabia and evaluated using electrocardiography (ECG), chest X-ray, BNP, pulmonary functions, ABG analysis, and transthoracic echocardiography. Multiple linear regression analysis was used to determine the predictors of right ventricular (RV) and left ventricular (LV) dysfunction. RESULTS Pulmonary hypertension (PH) was detected in 28% of the patients, while 25% had abnormal tricuspid annular plane systolic excursion (TAPSE). Low left ventricular ejection fraction (LVEF) and abnormal LV strain were present in 20%, abnormal right ventricular strain was present in 17%, and abnormal fractional area change (FAC) was detected in 9% of patients. Multiple linear regression analysis was used to explore possible determinants of cardiac function. Age, gender, and the presence of diabetes and hyperlipidemia were significant predictors of cardiac dysfunction in COPD patients. Forced vital capacity (FVC) was an independent predictor of LVEF (odds ratio, OR: 0.424, confidence interval, 95 CI%: 0.025-0.505, p<0.031) and FAC (OR: 0.496, 95 CI%: 0.008-655). Hypoxemia and hypercapnia significantly predict both RV and LV dysfunctions. BNP was an independent predictor of FAC (OR: 0.307, 95 CI%: -0.021, p<0.001). CONCLUSION Cardiac abnormalities are common in moderate to very severe COPD patients. Echocardiography could be considered for the assessment of these patients even in the absence of a history of cardiac disease. Pulmonary functions, ABG, and BNP may offer additional predictive information on cardiac functions in COPD patients.
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Affiliation(s)
- Rehab A Mohammed
- Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
- Internal Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Layla A Mohamed
- Cardiology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
| | - Eman M Abdelsalam
- Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
| | - Hend M Maghraby
- Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
| | - Nasima M Elkenany
- Cardiology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
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Su X, Lei T, Yu H, Zhang L, Feng Z, Shuai T, Guo H, Liu J. NT-proBNP in Different Patient Groups of COPD: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2023; 18:811-825. [PMID: 37197601 PMCID: PMC10183357 DOI: 10.2147/copd.s396663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/29/2023] [Indexed: 05/19/2023] Open
Abstract
Purpose NT-proBNP, a peptide biomarker synthesized and secreted by cardiomyocytes in response to cardiac load, has gained attention in recent years for its potential role in respiratory diseases. Chronic Obstructive Pulmonary Disease (COPD), a chronic and progressive inflammatory condition affecting the respiratory system, is frequently associated with comorbidities involving the cardiovascular system. Consequently, the aim of this systematic review and meta-analysis was to evaluate the variations in NT-proBNP levels across distinct patient groups with COPD and establish a foundation for future investigations into the precise clinical significance of NT-proBNP in COPD. Methods The search databases for this study were conducted in PubMed, Excerpt Medica database (Embase), Web of Science (WOS), and Cochrane Library databases. Databases were searched for studies on the predictive value of NT-proBNP in adult COPD patients. Results A total of 29 studies (8534 participants) were included. Patients with stable COPD exhibit elevated levels of NT-proBNP [standardized mean difference(SMD) [95CI%]=0.51 [0.13,0.89]; p=0.0092]. COPD patients with predicted forced expiratory volume in 1 s (FEV1) < 50% exhibit significantly elevated levels of NT-proBNP compared to those with FEV1 ⩾50%[SMD [95CI%]=0.17 [0.05,0.29]; p=0.0058]. NT-proBNP levels were significantly higher in acute exacerbations (AECOPD) compared to patients with stable COPD [SMD [95CI%]=1.18 [0.07,2.29]; p=0.037]. NT-proBNP levels was significantly higher in non-survivors than in survivors of hospitalised AECOPD patients [SMD [95CI%]=1.67 [0.47,2.88]; p=0.0063]. Both COPD patients with pulmonary hypertension(PH) [SMD [95CI%]=0.82 [0.69,0.96]; p<0.0001] and chronic heart failure(CHF) [SMD [95CI%]=1.49 [0.96,2.01]; p<0.0001] showed higher NT-proBNP level. Conclusion NT-proBNP, a biomarker commonly used in clinical practice to evaluate cardiovascular disease, demonstrates significant variations in different stages of COPD and during the progression of the disease. The fluctuations in NT-proBNP levels could be indicative of the severity of pulmonary hypoxia and inflammation and cardiovascular stress among COPD patients. Therefore, assessing NT-proBNP levels in COPD patients can aid in making informed clinical decisions.
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Affiliation(s)
- Xiaojie Su
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Ting Lei
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Haichuan Yu
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Lu Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Zhouzhou Feng
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Tiankui Shuai
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Hong Guo
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
| | - Jian Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Lanzhou University, Lanzhou City, Gansu Province, People’s Republic of China
- Correspondence: Jian Liu, Department of Clinical Medicine, the First Clinical Medical College of Lanzhou University, No. 1, Donggang West Road, Chengguan District, Lanzhou City, Gansu Province, People’s Republic of China, Tel +86 136 0935 4197, Email
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Ra F, Cl G, Pb S, Rs M, Sm F, Fpg R, Rg M, A BS, Mg R. Association of right ventricle diastolic diameter with pulmonary function, exercise tolerance and exacerbation period in patients with chronic obstructive pulmonary disease: A prospective study. Heart Lung 2022; 55:11-15. [PMID: 35427832 DOI: 10.1016/j.hrtlng.2022.04.003] [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: 11/24/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The echocardiogram is a useful method for monitoring the cardiovascular complications of chronic obstructive pulmonary disease (COPD), but it is not clear if morphological and functional cardiac variables are able to identify patients with unfavorable COPD progression. OBJECTIVE The aim of this study was to investigate morphological and functional echocardiographic variables associated with exacerbation of the disease, pulmonary function parameters and functional capacity evaluation in COPD patients. METHOD A longitudinal observational study including 91 patients diagnosed with COPD, who were stratified in two groups according to their basal right ventricle diastolic diameter (RVDD) measuring greater and less than 35 mm. They underwent clinical evaluation, echocardiography, spirometry and 6-minute walking-test (6MWT). RESULTS The study found that patients with RVDD greater than 35 mm showed worse functional capacity in the 6MWT (p = 0.05) and more exacerbation of the disease during the one-year follow-up (p = 0.05). There were correlations of greater RVDD vs forced vital capacity (R = -0.27; p = 0.02) and distance in the 6MWT (R = 0.55; p = 0.03) in patients with exacerbation. In the univariate regression analysis, the RVDD was responsible for 55% of the variation in distance in the 6MWT (-0.75 m) in COPD patients. CONCLUSION The RV dilation is associated with unfavorable prognostic markers in COPD, such as the worsening of the functional capacity and more frequent exacerbations. The echocardiogram may be a useful tool to identify patients who need more aggressive strategies to control the evolution of the disease with potential impact in pulmonary rehabilitation.
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Affiliation(s)
- Faria Ra
- Biotechnology, Cardiology and Exercise Research Center Laboratory, Department of Medicine, Federal University of São Carlos, SP, Brazil
| | - Goulart Cl
- Physiotherapy, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Santos Pb
- Federal University of São Carlos, SP, Brazil
| | - Marinho Rs
- Physiotherapy, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Firmino Sm
- Federal University of São Carlos, SP, Brazil
| | - Rizzatti Fpg
- Department of Medicine, Pulmonary Division, São Paulo Federal University, São Paulo, Brazil
| | - Mendes Rg
- Physiotherapy Department, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Borghi-Silva A
- Physiotherapy Department, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Roscani Mg
- Department of Medicine, Cardiology and Exercise Research Center Laboratory Coordinator, Department of Medicine, Federal University of São Carlos, Washington Luiz, Km 235, São Carlos, SP, Brazil.
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