Treatable cardiac disease in hospitalised COPD exacerbations

Paul Leong; Martin I. MacDonald; Paul T. King; Christian R. Osadnik; Brian S. Ko; Shane A. Landry; Kais Hamza; Ahilan Kugenasan; John M. Troupis; Philip G. Bardin

doi:10.1183/23120541.00756-2020

Abstract

Introduction Acute exacerbations of COPD (AECOPD) are accompanied by escalations in cardiac risk superimposed upon elevated baseline risk. Appropriate treatment for coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) could improve outcomes. However, securing these diagnoses during AECOPD is difficult, so their true prevalence remains unknown, as does the magnitude of this treatment opportunity. We aimed to determine the prevalence of severe CAD and severe HFrEF during hospitalised AECOPD using dynamic computed tomography (CT).

Methods A cross-sectional study of 148 patients with hospitalised AECOPD was conducted. Dynamic CT was used to identify severe CAD (Agatston score ≥400) and HFrEF (left ventricular ejection fraction ≤40% and/or right ventricular ejection fraction ≤35%).

Results Severe CAD was detected in 51 of 148 patients (35%), left ventricular systolic dysfunction was identified in 12 cases (8%) and right ventricular systolic dysfunction was present in 18 (12%). Clinical history and examination did not identify severe CAD in approximately one-third of cases and missed HFrEF in two-thirds of cases. Elevated troponin and brain natriuretic peptide did not differentiate subjects with severe CAD from nonsevere CAD, nor distinguish HFrEF from normal ejection fraction. Undertreatment was common. Of those with severe CAD, only 39% were prescribed an antiplatelet agent, and 53% received a statin. Of individuals with HFrEF, 50% or less received angiotensin blockers, beta blockers or antimineralocorticoids.

Conclusion Dynamic CT detects clinically covert CAD and HFrEF during AECOPD, identifying opportunities to improve outcomes via well-established cardiac treatments.

Abstract

Severe, treatable cardiac disease is present during hospitalised #AECOPD exacerbations, and is often clinically unsuspected. This cardiac disease can be detected with dynamic CT. Appropriate treatment could change outcomes. https://bit.ly/2Is45wO

Footnotes

This article has supplementary material available from openres.ersjournals.com.
This study is registered at www.anzctr.org.au with identifier number ACTRN12617001562369. Institutional ethics approval was obtained for data sharing in aggregated and deidentified formats only.
Author contributions: Conception, design: P. Leong, M.I. MacDonald, P. King, C.R. Osadnik, B.S. Ko, A. Kugenasan, J.M. Troupis and P.G. Bardin; acquisition and analysis: P. Leong, M.I. MacDonald, B.S. Ko, S.A. Landry, K. Hamza, A. Kugenasan and J.M. Troupis; interpretation: P. Leong, M.I. MacDonald, P. King, C.R. Osadnik, B.S. Ko, J.M. Troupis and P.G. Bardin; first draft: P. Leong. All authors participated in revising the work, agreed to submit this version for publication, and agree to be accountable for all aspects of the work.
Conflict of interest: P. Leong has nothing to disclose.
Conflict of interest: M.I. MacDonald has nothing to disclose.
Conflict of interest: P. King has nothing to disclose.
Conflict of interest: C.R. Osadnik has nothing to disclose.
Conflict of interest: B.S. Ko reports personal fees from Canon Medical during the conduct of the study.
Conflict of interest: S.A. Landry has nothing to disclose.
Conflict of interest: K. Hamza has nothing to disclose.
Conflict of interest: A. Kugenasan has nothing to disclose.
Conflict of interest: J.M. Troupis has nothing to disclose.
Conflict of interest: P.G. Bardin has nothing to disclose.
Support statement: P. Leong is supported by the Australian National Health and Medical Research Council Postgraduate Scholarship, the Royal Australasian College of Physicians Dixon Award, and the Monash Lung and Sleep Institute. C.R. Osadnik was the recipient of a Lung Foundation Australia COPD Research Fellowship and is the recipient of a Rebecca L. Cooper Medical Research Foundation Project Grant, unrelated to the present work. Views expressed are those of the authors and may not represent those of the funding bodies. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.