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04-04-2013 | Respiratory | Article

Cardiac abnormalities ‘highly prevalent’ after first severe COPD exacerbation


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medwireNews: Results from a Spanish study show that cardiac abnormalities are common among chronic obstructive pulmonary disease (COPD) patients who have experienced their first severe exacerbation.

Indeed, Joan Albert Barberà (University of Barcelona) and team found that almost two-thirds of COPD patients who had been admitted to a hospital for the first time due to a COPD exacerbation had echocardiographic abnormalities.

"The proportion of patients presenting cardiac disorders remained high even after excluding those with cardiovascular risk factors [other than smoking], and it was unrelated to COPD severity," they comment in the European Respiratory Journal.

The researchers studied 342 COPD patients (average age 67.9 years), with a mean 52.4% of predicted forced expiratory volume in 1 second, who had been hospitalized for the first time due to an exacerbation. They underwent transthoracic echocardiography 3 months after discharge, when they were clinically stable.

Overall, 64% of the patients had significant echocardiographic abnormalities. Of the 181 patients in whom the right side of the heart could be adequately assessed, 48% showed significant abnormalities, and of the 278 patients in whom the left ventricle could be fully assessed, 27% had significant abnormalities.

Right ventricular enlargement and pulmonary hypertension were the most common abnormalities, affecting 30% and 19% of patients, respectively.

Furthermore, 29% of patients had left atrial dilatation, 13% had left ventricle systolic dysfunction, 12% had left ventricle diastolic impairment, and 6% had left ventricle enlargement.

The team also found that 63% of patients without previously diagnosed cardiovascular disease or associated risk factors, excluding smoking, had significant echocardiographic abnormalities.

No significant associations were observed between the presence of echocardiographic abnormalities and degree of airflow obstruction, distance walked on the 6-minute walk test, St George's Respiratory Questionnaire results, or other assessments of COPD severity.

Barberà et al conclude: "This large, prospective, multicentre, comprehensive echocardiographic study shows that cardiac disorders are highly prevalent in patients with moderate-to-severe COPD, even among those without cardiovascular risk factors other than cigarette smoking."

They add: "Whereas right heart abnormalities could be anticipated, such a high prevalence of left heart abnormalities is a novel and unexpected finding that was unrelated to disease severity.

"Accordingly, the implementation of echocardiography in the evaluation of COPD patients should be considered, since it might help detect unrecognised cardiac disorders and establish adequate treatment that may potentially improve patient prognosis."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Mark Cowen, Senior medwireNews Reporter

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