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Unrecognised ventricular dysfunction in COPD

A. Macchia, J.J. Rodriguez Moncalvo, M. Kleinert, P.D. Comignani, G. Gimeno, D. Arakaki, N. Laffaye, J.J. Fuselli, H.P. Massolin, J. Gambarte, M. Romero, G. Tognoni
European Respiratory Journal 2012 39: 51-58; DOI: 10.1183/09031936.00044411
A. Macchia
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  • For correspondence: macchia@negrisud.it
J.J. Rodriguez Moncalvo
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M. Kleinert
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P.D. Comignani
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G. Gimeno
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D. Arakaki
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N. Laffaye
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J.J. Fuselli
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H.P. Massolin
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J. Gambarte
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M. Romero
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G. Tognoni
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  • Figure 1–
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    Figure 1–

    Declared probability by pneumologists and its relationship with the actual finding of chronic heart failure (CHF).

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    Figure 2–

    Declared probability of cardiologists and its relationship with the actual finding of chronic obstructive pulmonary disease (COPD).

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    Figure 3–

    Kaplan–Meier estimates of survival of patients with chronic heart failure with airway obstruction (–––––) and without airway obstruction (-------). Hazard ratio 0.77 (95% CI 0.37–1.58); p=0.474.

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    Figure 4–

    Kaplan–Meier estimates of survival of patients with chronic obstructive pulmonary disease with left ventricular dysfunction (–––––) and without left ventricular dysfunction (-------). Hazard ratio 2.34 (95% CI 0.99–5.54); p=0.053.

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  • Table 1– Baseline characteristics of patients enrolled in the REPENSAR (Registro de Enfermedad Pulmonar obstructiva crónica E insuficiencia cardíaca en contextos Asistenciales Reales) registry
    All patientsCHFCOPDp-value
    Subjects n419201218
    Age yrs72.4±12.175.3±15.569.8±6.9<0.0001
    Males305 (72.8)139 (69.1)166 (76.1)0.10
    Cardiovascular risk factors
     Hypertension269 (64.2)156 (77.6)113 (51.8)<0.0001
     Smoking<0.0001
      Ever-smoker314 (74.9)104 (51.7)210 (96.3)
      Pack-yrs49±1633.3±1160.4±26
      Current smoker69 (16.5)17 (8.4)52 (23.8)
      Years of smoking35±1429±1439±13
     Hypercholesterolaemia182 (43.4)111 (55.2)71 (32.3)<0.0001
     Diabetes60 (14.3)46 (22.9)14 (6.4)<0.0001
     Coronary disease151 (36.0)115 (57.2)36 (16.5)<0.0001
     Stroke31 (7.4)21 (10.4)10 (4.6)<0.0001
     Vascular disease33 (7.9)15 (7.5)18 (8.3)0.76
    Other comorbidities
     Renal failure54 (12.9)44 (21.9)10 (4.6)<0.0001
     Malignancy41 (9.8)24 (11.9)17 (7.8)0.16
    Previous treatment
     ACE inhibitors203 (48.4)138 (68.6)65 (29.8)<0.0001
     Angiotensin receptor antagonists54 (12.9)32 (15.9)22 (10.1)0.08
     β-blockers179 (42.7)157 (78.1)22 (10.1)<0.0001
     Digitalis45 (10.7)42 (20.9)3 (1.4)<0.0001
     Diuretics208 (49.6)160 (79.6)48 (22)<0.0001
     Statins145 (34.6)104 (57.1)41 (18.9)<0.0001
     Selective β2-agonists100 (45.9)
     Associated β2-agonists156 (71.5)
     Inhaled steroids59 (27.1)
     Systemic steroids9 (4.1)
     Anticholinerics78 (35.8)
     Methyl xanthines16 (7.3)
     Oxygen8 (3.7)
    Baseline signs and symptoms
     Dyspnoea396 (94.5)186 (92.5)210 (96.3)0.09
     Chronic cough203 (48.4)39 (19.4)164 (75.2)<0.0001
     Oedema154 (36.8)113 (56.2)41 (18.9)<0.0001
     Third sound16 (3.8)13 (6.5)3 (1.4)<0.0001
    Baseline lung function
     Post-bronchodilator FEV1 L1.25±0.49
     FEV1 % pred39±16
     Post-bronchodilator FEV1/FVC %51±13
    Baseline echocardiogram
     Ejection fraction %32±9
     LVEDD mm59.7±9.6
     Pulmonary systolic pressure mm39.8 (12)
    • Data are presented as mean±sd or n (%), unless otherwise stated. CHF: chronic heart failure; COPD: chronic obstructive pulmonary disease; ACE: angiotensin-converting enzyme; FEV1: forced expiratory volume in 1 s; % pred: % predicted; FVC: forced vital capacity; LVEDD: left ventricular end-diastolic echo dimensions.

  • Table 2– Results of spirometry and classification of pulmonary function severity in patients with chronic heart failure
    ResultTotal subjectsFEV1FEV1 %FEV1/FVC
    No obstruction126 (62.7)2.07±0.7881±2180±9
    GOLD I13 (6.5)2.43±0.4887±765±3
     FEV1/FVC <0.70
     FEV1 ≥80%
    GOLD II36 (17.9)1.69±0.5264±962±7
     FEV1/FVC <0.70
     50%≤ FEV1 <80%
    GOLD III25 (12.4)1.18±0.3343±555±10
     FEV1/FVC <0.70
     30%≤ FEV1 <50%
    GOLD IV1 (0.5)0.72163
     FEV1/FVC <0.70
     FEV1 <30% or FEV1 <50% and respiratory failure
    • Data are presented as n (%) or mean±sd, unless otherwise stated. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; GOLD: Global Initiative for Chronic Obstructive Lung Disease.

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Unrecognised ventricular dysfunction in COPD
A. Macchia, J.J. Rodriguez Moncalvo, M. Kleinert, P.D. Comignani, G. Gimeno, D. Arakaki, N. Laffaye, J.J. Fuselli, H.P. Massolin, J. Gambarte, M. Romero, G. Tognoni
European Respiratory Journal Jan 2012, 39 (1) 51-58; DOI: 10.1183/09031936.00044411

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Unrecognised ventricular dysfunction in COPD
A. Macchia, J.J. Rodriguez Moncalvo, M. Kleinert, P.D. Comignani, G. Gimeno, D. Arakaki, N. Laffaye, J.J. Fuselli, H.P. Massolin, J. Gambarte, M. Romero, G. Tognoni
European Respiratory Journal Jan 2012, 39 (1) 51-58; DOI: 10.1183/09031936.00044411
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