RT Journal Article
SR Electronic
T1 Treatable cardiac disease in hospitalised COPD exacerbations
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00756-2020
DO 10.1183/23120541.00756-2020
VO 7
IS 1
A1 Paul Leong
A1 Martin I. MacDonald
A1 Paul T. King
A1 Christian R. Osadnik
A1 Brian S. Ko
A1 Shane A. Landry
A1 Kais Hamza
A1 Ahilan Kugenasan
A1 John M. Troupis
A1 Philip G. Bardin
YR 2021
UL http://openres.ersjournals.com/content/7/1/00756-2020.abstract
AB 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.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