Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) as a Cardiovascular Risk Factor
Date Issued
2020-01
Author(s)
Abstract
Background: AECOPD are accompanied by increased cardiovascular
risk because of systemic inflammation, hypoxia, age, cigarette smoking.
Recent data suggest an increased risk of myocardial infarction in the
following days of a severe exacerbation of COPD, and around 30%
die from cardiovascular diseases. Cardiac dysfunction in AECOPD is
often underestimated and underdiagnosed at the time of admission,
because decompensated cardiac failure and AECOPD share symptom
similarities.
Objective: To investigate the presence of increased cardiovascular risk
in hospitalized patients with emphysema and AECOPD.
Materials and Methods: Observational study, 120 hospitalized
AECOPD patients and 60 stable COPD controls, matched by age, gender
and body mass index. Inclusion criteria: age 40–75, cigarette smoking
history >=10 pack/years, signed consent for participation. All patients
underwent laboratory tests, pulmonary function tests, chest-X ray,
electrocardiogram (ECG), 2D-Doppler echocardiography.
Results: Systolic or diastolic left ventricular dysfunction was noted in
66.7% of investigated group. Right ventricular (RV) abnormalities were
significantly higher in investigated group than controls (p<0.001), with RV
systolic dysfunction in 62.5%, pulmonary hypertension 54,2%, tricuspid
regurgitation 53.3%. According to ECG findings 67% had abnormal ECG,
and 33% had a new abnormality from baseline. Atrial premature beats
were detected in 66.7%, ventricular premature beats 41.7%, un-sustained
ventricular tachycardia 5%, atrio-ventricular block of first degree 5%, right
bundle branch block 33.3%, atrial fibrillation 15%, T-wave changes 33.3%,
ECG signs of previous infarction in 25%. An abnormal ECG, particularly
with ischemic changes, on presentation to the emergency department
with AECOPD, is correlated with a prolonged hospital stay (Image 1).
AECOPD is associated with greater prolongation of P wave dispersion
than in stable COPD. Patients with fatal arrhythmias had QTc interval
greater than 440ms. Elevated troponins have been associated with the
elderly, comorbid heart failure, chronic renal failure, atrial fibrillation.
Correlation between pH value and fatal arrhythmias risk in investigatedgroup, showed that respiratory acidosis was associated with higher risk
of fatal outcome (p<0.001).
Conclusions: Acute exacerbations of COPD may trigger cardiac
events. Cardiac treatments could improve AECOPD outcomes induced
by respiratory infections in COPD patients, so early detection of
unrecognized coexisting cardiac disorders is significant. Further research
into the pathogenesis and treatment of acute cardiac dysfunction in
COPD exacerbations are needed.
risk because of systemic inflammation, hypoxia, age, cigarette smoking.
Recent data suggest an increased risk of myocardial infarction in the
following days of a severe exacerbation of COPD, and around 30%
die from cardiovascular diseases. Cardiac dysfunction in AECOPD is
often underestimated and underdiagnosed at the time of admission,
because decompensated cardiac failure and AECOPD share symptom
similarities.
Objective: To investigate the presence of increased cardiovascular risk
in hospitalized patients with emphysema and AECOPD.
Materials and Methods: Observational study, 120 hospitalized
AECOPD patients and 60 stable COPD controls, matched by age, gender
and body mass index. Inclusion criteria: age 40–75, cigarette smoking
history >=10 pack/years, signed consent for participation. All patients
underwent laboratory tests, pulmonary function tests, chest-X ray,
electrocardiogram (ECG), 2D-Doppler echocardiography.
Results: Systolic or diastolic left ventricular dysfunction was noted in
66.7% of investigated group. Right ventricular (RV) abnormalities were
significantly higher in investigated group than controls (p<0.001), with RV
systolic dysfunction in 62.5%, pulmonary hypertension 54,2%, tricuspid
regurgitation 53.3%. According to ECG findings 67% had abnormal ECG,
and 33% had a new abnormality from baseline. Atrial premature beats
were detected in 66.7%, ventricular premature beats 41.7%, un-sustained
ventricular tachycardia 5%, atrio-ventricular block of first degree 5%, right
bundle branch block 33.3%, atrial fibrillation 15%, T-wave changes 33.3%,
ECG signs of previous infarction in 25%. An abnormal ECG, particularly
with ischemic changes, on presentation to the emergency department
with AECOPD, is correlated with a prolonged hospital stay (Image 1).
AECOPD is associated with greater prolongation of P wave dispersion
than in stable COPD. Patients with fatal arrhythmias had QTc interval
greater than 440ms. Elevated troponins have been associated with the
elderly, comorbid heart failure, chronic renal failure, atrial fibrillation.
Correlation between pH value and fatal arrhythmias risk in investigatedgroup, showed that respiratory acidosis was associated with higher risk
of fatal outcome (p<0.001).
Conclusions: Acute exacerbations of COPD may trigger cardiac
events. Cardiac treatments could improve AECOPD outcomes induced
by respiratory infections in COPD patients, so early detection of
unrecognized coexisting cardiac disorders is significant. Further research
into the pathogenesis and treatment of acute cardiac dysfunction in
COPD exacerbations are needed.
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