What is the impact of impaired left ventricular ejection fraction in COPD after adjusting for confounders?
Introduction
Cardiac problems are common and associated with important morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) [1], [2]. Previous reports suggest a prevalence between 14 and 33% of cardiac diseases in patients with COPD [3]. Lower-limb muscle weakness, exercise intolerance, impaired body composition and reduced daily activity level can be found in patients with COPD or heart failure compared to healthy peers [4]. Therefore, it seems reasonable to hypothesize that the presence of cardiac problems in patients with COPD would have an additional negative impact on physical and psychological status. Indeed, COPD patients with a medical history of ischemic heart disease were found to have worse quality of life, lower 6-minute walk distance, and more breathlessness than COPD patients without ischemic heart disease [5].
Other studies have also suggested a negative impact of self-reported cardiac diseases on health outcome measures in patients with COPD [2], [6], [7]. Nevertheless, the diagnosis of the cardiac condition in most of these studies was based on non-objective measures (e.g., medical history, self-reports), which is less accurate than echocardiography, and in some studies relevant characteristics differed between groups, which may explain the significant differences in exercise capacity [2], [6]. To date, the additional impact of objectively assessed cardiac impairments, such as an impaired left ventricular ejection fraction (LVEF), on physical and psychological status in matched groups of patients with COPD has never been studied. Identifying and understanding the impact of cardiac impairments on COPD patients' physical and psychological status may contribute to a better management and treatment of patients with COPD.
The aim of this study was to compare physical and psychological status between COPD patients with and without impaired LVEF referred for pulmonary rehabilitation (PR). A priori, we hypothesised that COPD patients with impaired LVEF will have worse physical and psychological status compared with matched COPD patients with normal LVEF. Although this hypothesis may seem axiomatic, to the best of our knowledge no study has tested it before.
Section snippets
Study design and participants
This is a cross-sectional analysis with data from the COPD, health status and comorbidities (Chance) study [8]. In brief, the Chance study was designed to investigate the impact of cardiovascular comorbidities on health status in patients with COPD. Eligibility criteria were: age 40–85 years, COPD diagnosis according to the Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines [9], no recent exacerbation (previous 4 weeks) or condition influencing health status not related to
General characteristics
COPD severity in both groups ranged from mild to very severe, but most patients had moderate or severe disease (Table 1). The average resting blood gas values were normal. Patients with and without impaired LVEF were similar in terms of demographics, smoking status, proportion of long-term oxygen therapy users, exacerbation history, and lung function, except for lung diffusing capacity which was worse in patients with impaired LVEF (Table 1). The degree of static hyperinflation (based on the
Discussion
We demonstrated for the first time that COPD patients with impaired LVEF have worse exercise capacity, quadriceps muscle function, and functional mobility than matched COPD patients with normal LVEF. Moreover, patients with impaired LVEF had more symptoms of anxiety and depression than patients with normal LVEF. These findings have clinical importance for the management of COPD patients, especially when considering the high prevalence of cardiac problems among these patients [1].
Cardiovascular
Conclusions
In summary, this study demonstrates that an impaired LVEF has a clear negative impact on physical and psychological status in patients with COPD, even after matching for sex, age, BMI and FEV1. This reinforces the importance of assessing and treating cardiac comorbidities in COPD.
Conflict of interest
Rafael Mesquita, Frits M. E. Franssen, Sarah Houben-Wilke, Nicole H. M. K. Uszko-Lencer, Lowie E. G. W. Vanfleteren, Yvonne M. J. Goërtz, Fabio Pitta, and Martijn A. Spruit report no relationships that could be construed as a conflict of interest. Emiel F. M. Wouters reports personal fees from Nycomed, AstraZeneca, GSK and Novartis, outside the submitted work.
Acknowledgement of grant support
RM is supported by CNPq, Conselho Nacional de Desenvolvimento Científico e Tecnológico – Brazil (246704/2012-8). This study was funded by Lung Foundation Netherlands (3.4.10.015) and GSK (SCO115406).
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Cited by (15)
Determinants of functional, peak and endurance exercise capacity in people with chronic obstructive pulmonary disease
2018, Respiratory MedicineCitation Excerpt :The aim of this study was to: 1) ascertain the relationship between the different constructs of exercise performance, namely functional exercise capacity measured by the 6MWT, peak exercise capacity measured by a symptom-limited incremental cycle test, and endurance exercise capacity measured by a sub-maximal constant work rate cycle test to symptom limitation, with personal and clinical characteristics including cardiac function (resting echocardiography and N-terminal pro-brain natriuretic peptide (NT-proBNP) level), measurements of resting pulmonary function, physical function, health and psychological status and co-morbid conditions in people with COPD; and, 2) to investigate the main clinical and functional determinants of exercise capacity. This study was a new cross-sectional analysis of data from the Chance (COPD, health status and comorbidities) study which was a prospective observational single-centre study investigating the impact of cardiovascular comorbidities on health status in people with COPD between April 2012 and September 2014 in the Netherlands [23–25]. The study was approved by the Medical Ethics Committee of the Maastricht University Medical Centre+ (METC 11-3-070), and registered in the Dutch Trial Register (NTR 3416).
Physical and psychological status of patients with COPD and impaired LVEF: Two bads don't make a good
2017, International Journal of CardiologyCOPD and Cardiovascular Disease
2019, PulmonologyCitation Excerpt :Current guidelines reinforce the idea that the control of comorbidities has a clear benefit over the potential risks associated with the use of these drugs and there is no clear evidence sustaining these fears.5–7,10,23 For example, Mesquita et al conducted a research study involving COPD patients with and without impaired left ventricular ejection fraction (LVEF) and found that only half of the cohort with impaired LVEF was under targeted therapy for heart failure.9 On the other hand, the true survival benefits of aggressive treatment of cardiac disease and COPD in patients with both conditions are still not clarified.2
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This author takes responsibility for all aspects of the reliability and freedom
from bias of the data presented and their discussed interpretation.