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Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease

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Abstract

Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p < 0.05 for all comparisons). HFpEF was not independently associated with all-cause mortality [hazard ratio (HR) 1.07, 95 % confidence interval (CI) 0.44–2.62]. Global initiative for chronic Obstructive Lung Disease (GOLD) stage (IV vs. I–III, HR 2.37, CI 1.23–4.59) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels (HR 2.79, CI 1.12–6.98) were independent predictors of long-term survival. HFpEF is present in one-fifth of patients with exacerbated COPD. Non-invasively diagnosed HFpEF may not be an independent predictor of all-cause mortality. Elevated NT-proBNP levels and very severe COPD were independently associated with unfavorable overall survival.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

FEV1:

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

GOLD:

Global initiative on obstructive lung disease

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

NT-proBNP:

N-terminal pro B-type natriuretic peptide levels

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Acknowledgments

BP and ANN are partially supported by the Grant No. 175099 of the Ministry of Science, Republic of Serbia.

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Authors and Affiliations

  1. University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia

    Robert Marcun & Sasa Kadivec

  2. Department of Cardiology, Faculty of Medicine, Clinical Hospital Center Zemun, University of Belgrade, Belgrade, Serbia

    Ivan Stankovic, Radosav Vidakovic, Biljana Putnikovic, Ivan Ilic & Aleksandar N. Neskovic

  3. Chair of Public Health, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Jerneja Farkas

  4. Department of Cardiology, General Hospital Celje, Oblakova cesta 5, 3000, Celje, Slovenia

    Mitja Lainscak

  5. Chair of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Mitja Lainscak

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  1. Robert Marcun
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Correspondence to Ivan Stankovic.

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Statement of human and animal rights

The study was conducted in accordance with the Declaration of Helsinki Principles, it was approved by the National Ethics Committee.

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Written informed consent was obtained from all patients.

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Marcun, R., Stankovic, I., Vidakovic, R. et al. Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease. Intern Emerg Med 11, 519–527 (2016). https://doi.org/10.1007/s11739-015-1319-0

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