Abstract
Background: Heart failure (HF) carries a dismal prognosis in COPD. There is an unmet clinical need for validation of reliable non-invasive prognosticators in this fast-growing sub-population. We therefore investigated the utility of resting echocardiography and cardiopulmonary exercise tests in predicting a short-term negative outcome in COPD-HF overlap.
Methods: After treatment optimization by a cardiologist and a respirologist, 30 patients (ejection fraction= 35.1 ± 6.5 %, FEV1= 62.4 ± 18.3 % pred) were followed-up for death or major cardiovascular events.
Results: 14/30 (46.6 %) patients had a negative outcome after a median (IQR) follow-up of 359 (370) days. There was no significant association between left ventricular echocardiographic variables and a negative outcome (p>0.05). In contrast, event-positive patients had significantly lower right ventricular fractional area change (RVFAC= 40.6 ± 11.6 % vs. 49.0 ± 8.2 %; p<0.05). Among the exercise variables, event-positive patients had higher ventilatory inefficiency and lower peak end-tidal partial pressure for CO2 (PETCO2) (p<0.01). In fact, RVFAC and PETCO2 were the only independent predictors of a short term negative outcome (Figure).
Conclusion: Resting echocardiographic and CPET variables suggesting RV-pulmonary vascular impairment reliably predicted short term clinical deterioration or death in COPD-HF overlap.
- Copyright ©ERS 2015