Obstructive Lung Diseases |

Impact of Chronic Obstructive Pulmonary Disease on Echocardiographic Parameters in Patients Hospitalized With Acute Decompensated Heart Failure FREE TO VIEW

Jignesh Patel*, MD; Hal Skopicki, MD; Puja Parikh, MD; Abhijeet Singh, MD; Smadar Kort, MD
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Stony Brook University Medical Center, Stony Brook, NY

Chest. 2012;142(4_MeetingAbstracts):668A. doi:10.1378/chest.1390560
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PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Chronic obstructive pulmonary disease (COPD) may complicate the clinical prognosis of the heart failure patient. We sought to evaluate the impact of COPD on echocardiographic characteristics in patients admitted with acutely decompensated heart failure (ADHF).

METHODS: Echocardiograms were performed upon hospital admission for 181 patients admitted with a primary diagnosis of ADHF to a tertiary teaching hospital from January 2007 to June 2008. Echocardiographic parameters examined included left ventricular ejection fraction (LVEF), LV cavity size, left atrial (LA) size, interventricular septum (IVS), LV posterior width (LVPW), presence and severity of mitral (MR) and tricuspid regurgitation (TR), transmitral early (E) and late (A) filling velocities, deceleration times, mitral annular early diastolic velocities (E’), right ventricular (RV) and right atrial (RA) cavity sizes, and RV systolic pressure (RVSP).

RESULTS: Among 181 patients, 40 (22.1%) patients reported a history of COPD while 141 (77.9%) reported no such history. No significant difference was noted with respect to age (74 vs 71 years, p=0.250) or gender (males 48% vs 58%, p=0.231) between COPD and non-COPD patients; however, a trend toward higher rates of diabetes (58% vs 40%, p=0.055) was noted in the COPD group. COPD patients had significantly higher LVEF (45% vs 38%, p=0.034) and a trend towards lower rates of significant MR (15% vs 30%, p=0.068). No differences were noted in LV and LA cavity size, IVS, LVPW, transmitral E and A velocities, mitral deceleration times, RV enlargement, RVSP, RA size, and significant TR. COPD patients, however, were found to have higher average E’ velocity (11.8cm/s vs 7.7cm/s, p=0.029), but no difference in average E/E’ ratios (14.7 vs 15.2, p=0.826). Patients with COPD also had higher serum bicarbonate and troponin-I levels but no difference in admission B-type natriuretic peptide (BNP) levels. COPD patients demonstrated a trend towards higher rates of all-cause mortality at six months (23% vs 11%, p=0.071).

CONCLUSIONS: Co-existing COPD in patients admitted with ADHF is associated with worse prognosis, despite better LV systolic function.

CLINICAL IMPLICATIONS: Patients with heart failure and comorbid COPD may require more frequent followup and closer monitoring to reduce the risk of adverse cardiac events.

DISCLOSURE: The following authors have nothing to disclose: Jignesh Patel, Hal Skopicki, Puja Parikh, Abhijeet Singh, Smadar Kort

No Product/Research Disclosure Information

Stony Brook University Medical Center, Stony Brook, NY




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