Obstructive Lung Diseases |

Pulmonary Hypertension and Systemic Inflammation Are Independent Determinants of Cardiac Stress in Patients With Obstructive Lung Disease FREE TO VIEW

Siegfried Wieshammer, MD; Jens Dreyhaupt, PhD; Julia Neufang, MD
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Offenburg Hospital, Offenburg, Germany

Chest. 2013;144(4_MeetingAbstracts):697A. doi:10.1378/chest.1703499
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SESSION TITLE: COPD Diagnosis & Evaluation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Advanced obstructive lung disease is often associated with systemic inflammation (SI), whereas less than 25 % of these patients have pulmonary hypertension (PAH). The serum levels of C-reactive protein (CRP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) are quantitative markers of SI and cardiac stress, respectively. This study aimed to investigate the effects of SI, PAH and their interaction on NT-proBNP.

METHODS: A series of 480 patients with asthma or chronic obstructive pulmonary disease were assigned to 4 strata according to the absence or presence of SI (CRP ≤5 mg/L versus >5 mg/L) and PAH (systolic gradient across the tricuspid valve measured with continuous-wave Doppler <30 mmHg versus ≥30 mmHg). The patients without evidence of SI and PAH (n = 323) were used as the reference group (stratum 1). The logarithmically transformed values for NT-proBNP [ln (NT-proBNP)] were adjusted for important cardiac and extracardiac covariates.

RESULTS: The prevalence of ≥moderately severe airway obstruction was 25.9 %. The presence of SI was associated with both increased odds of ≥moderately severe airway obstruction [odds ratio (OR) 2.5, 95%-confidence interval (95%-CI) 1.3, 4.9] and PAH [OR 2.1, 95%-CI 1.1, 4.1] after adjustment for age, hemoglobin level and the presence of left heart disease. As compared to stratum 1, the fully adjusted values for ln (NT-proBNP) were higher (p <0.01) in patients with SI and no PAH (n = 102; stratum 2), no SI and PAH (n = 27, stratum 3) and SI and PAH (n = 28, stratum 4). The presence of SI did not interfere with the impact of PAH on ln (NT-proBNP). Moving from stratum 1 to stratum 4 increased the ln (NT-proBNP) values 0.9 as much as the presence of impaired left ventricular systolic function.

CONCLUSIONS: SI and PAH are major and independent determinants of cardiac stress in patients with obstructive lung disease.

CLINICAL IMPLICATIONS: The presence of both SI and PAH might identify a subset of patients with a particularly high cardiovascular risk.

DISCLOSURE: The following authors have nothing to disclose: Siegfried Wieshammer, Jens Dreyhaupt, Julia Neufang

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