Elsevier

International Journal of Cardiology

Volume 225, 15 December 2016, Pages 365-370
International Journal of Cardiology

What is the impact of impaired left ventricular ejection fraction in COPD after adjusting for confounders?

https://doi.org/10.1016/j.ijcard.2016.10.016Get rights and content

Abstract

Background

It remains unknown whether and to what extent impaired left ventricular ejection fraction (LVEF) affects physical and psychological status in COPD. We aimed to compare health outcome measures between COPD patients with and without impaired LVEF after adjusting for age, sex, BMI and FEV1.

Methods

Impaired LVEF was defined as values < 50%. 85 COPD patients with impaired LVEF and 85 COPD patients with normal LVEF were matched for sex, age, BMI and FEV1. Exercise capacity, quadriceps muscle function, functional mobility, inflammatory status, health status, care dependency, and mood disorders were cross-sectionally assessed.

Results

Patients with impaired LVEF had shorter 6-minute walk distance (mean − 59 (95% confidence interval: − 94, − 25) m), lower symptom-limited peak oxygen uptake (− 131 (− 268, 7) ml/min), weaker quadriceps muscles (− 12 (− 20, − 3) Nm) and had more symptoms of anxiety (+ 2 (1, 3) points) and depression (+ 1 (0, 2) points) than those with normal LVEF (all P < 0.05). Health status was not statistically different between groups (P > 0.05).

Conclusions

Impaired LVEF has a clear impact on physical and psychological status in patients with COPD, even after adjusting for confounders. This reinforces the importance of assessing and treating cardiac problems in COPD.

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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