Cardiovascular Diseases Undiagnosed and Untreated in Large COPD Cohort

A substantial number of participants in a large COPD cohort had undiagnosed and untreated cardiovascular diseases as revealed by a review of echocardiogram data, according to the results of a study published in the International Journal of Chronic Obstructive Pulmonary Disease.

Baseline data from patients enrolled in the COPD cohort of a large prospective study (COSYCONET) were analyzed to determine the cardiovascular contribution to COPD symptoms. Researchers used the parameters of lung function (including forced expiratory volume in 1 second [FEV1], residual volume/total lung capacity (RV/TLC) ratio, diffusing capacity (TLCO), echocardiographic data on left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD), as well as any history of cardiac disorders, and use of medications to investigate contributions and comorbidities.

Among the 1591 study participants with COPD, 289 reported a history of any type of cardiac disease, including ischemic heart disease, myocardial infarction, and heart failure. Furthermore, 860 patients were receiving ≥1 cardiovascular medication. In addition, LVEF<50% or LVEDD >56 mm (study defined parameters for cardiac function impairment) was found in 204 patients, of whom 74 had no history of cardiovascular disease or medication use. Among 948 patients without isolated hypertension, 21 of 55 patients with LVEF<50% and 47 of 88 with LVEDD>56 mm lacked both a cardiac diagnosis and medication; further, 3 and 6 patients, respectively, were receiving cardiovascular medications without a parallel diagnosis.

The investigators noted that the results were concurrent with previous studies, and indicated that lung function may be a determinant of other indices of disease. Further, although the effects of lung function on exertion symptoms of COPD correlated to findings of previous studies, the results also highlighted the significant and directly proportional association between LVEDD and symptomology. However, there was no association in regards to effects of LVEF. This suggests that cardiac morphology may be more influential on COPD symptoms compared with cardiac function.

The study authors concluded, “A remarkable proportion of patients with suspicious echocardiographic findings were undiagnosed and untreated, implying an increased risk for an unfavorable prognosis.” They added, “There was a small direct contribution of left ventricular size to COPD symptoms, irrespective of all other influencing factors.”

Reference

Alter P, Mayerhofer BA, Kahnert K, et al. Prevalence of cardiac comorbidities, and their underdetection and contribution to exertional symptoms in COPD: results from the COSYCONET cohort. Int J Chron Obstruct Pulmon Dis. 2019;14:2163-2172.