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Kibbler J, Wade C, Mussell G, Ripley DP, Bourke SC, Steer J. Systematic review and meta-analysis of prevalence of undiagnosed major cardiac comorbidities in COPD. ERJ Open Res 2023; 9:00548-2023. [PMID: 38020568 PMCID: PMC10680032 DOI: 10.1183/23120541.00548-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background It is often stated that heart disease is underdiagnosed in COPD. Evidence for this statement comes from primary studies, but these have not been synthesised to provide a robust estimate of the burden of undiagnosed heart disease. Methods A systematic review of studies using active diagnostic techniques to establish the prevalence of undiagnosed major cardiac comorbidities in patients with COPD was carried out. MEDLINE, Embase, Scopus and Web of Science were searched for terms relating to heart failure (specifically, left ventricular systolic dysfunction (LVSD), coronary artery disease (CAD) and atrial fibrillation), relevant diagnostic techniques and COPD. Studies published since 1980, reporting diagnosis rates using recognised diagnostic criteria in representative COPD populations not known to have heart disease were included. Studies were classified by condition diagnosed, diagnostic threshold used and whether participants had stable or exacerbated COPD. Random-effects meta-analysis of prevalence was conducted where appropriate. Results In general, prevalence estimates for undiagnosed cardiac comorbidities in COPD had broad confidence intervals, with significant study heterogeneity. Most notably, a prevalence of undiagnosed LVSD of 15.8% (11.1-21.1%) was obtained when defined as left ventricular ejection fraction <50%. Undiagnosed CAD was found in 2.3-18.0% of COPD patients and atrial fibrillation in 1.4% (0.3-3.5%). Conclusion Further studies using recent diagnostic advances, and investigating therapeutic interventions for patients with COPD and heart disease are needed.
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Affiliation(s)
- Joseph Kibbler
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Clare Wade
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
| | - Grace Mussell
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - David P. Ripley
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
| | - Stephen C. Bourke
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Newcastle University, Translation and Clinical Research Institute, Newcastle upon Tyne, UK
| | - John Steer
- Northumbria Healthcare NHS Foundation Trust, Respiratory Medicine, North Shields, UK
- Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
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2
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Shafuddin E, Fairweather SM, Chang CL, Tuffery C, Hancox RJ. Cardiac biomarkers and long-term outcomes of exacerbations of COPD: a long-term follow-up of two cohorts. ERJ Open Res 2021; 7:00531-2020. [PMID: 33644222 PMCID: PMC7897844 DOI: 10.1183/23120541.00531-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/26/2020] [Indexed: 11/05/2022] Open
Abstract
Background COPD patients often have cardiac comorbidities. Cardiac involvement at the time of a COPD exacerbation is associated with a high short-term mortality, but whether this influences long-term outcomes is unknown. We explored whether biomarkers of cardiac dysfunction at the time of a COPD exacerbation predict long-term outcomes. Methods Two prospective cohorts of patients admitted to Waikato Hospital for exacerbations of COPD were recruited during 2006-2007 and 2012-2013. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin T were measured on admission and were used to indicate cardiac stretch and myocardial injury, respectively. 5-year survival after discharge and subsequent admissions for cardiac disease and COPD exacerbations were analysed using Kaplan-Meier and Cox proportional hazards tests. Results The overall 5-year mortality was 61%. Patients with high NT-proBNP on admission had higher mortality than those with normal cardiac biomarkers (adjusted hazard ratio (aHR) 1.76, 95% CI 1.18-2.62). High NT-proBNP was also associated with a higher risk of future cardiac admissions (aHR 1.75, 95% CI 1.2-2.55). Troponin T levels were not associated with long-term survival (aHR 0.86, 95% CI 0.40-1.83) or future cardiac admissions (aHR 0.74, 95% CI 0.34-1.57). Neither biomarker predicted future COPD exacerbations. Conclusion The long-term prognosis following a hospitalisation for an exacerbation of COPD is poor with less than half of patients surviving for 5 years. Elevated NT-proBNP at the time of a COPD exacerbation is associated with higher long-term mortality and a greater likelihood of future cardiac admissions, but not future COPD exacerbations.
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Affiliation(s)
- Eskandarain Shafuddin
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,These authors contributed equally
| | - Sarah M Fairweather
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,These authors contributed equally
| | - Catherina L Chang
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Christine Tuffery
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,Dept of Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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3
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Gracie K, Hancox RJ. Cannabis use disorder and the lungs. Addiction 2021; 116:182-190. [PMID: 32285993 DOI: 10.1111/add.15075] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/04/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
Cannabis is one of the world's most widely used recreational drugs and the second most commonly smoked substance. Research on cannabis and the lungs has been limited by its illegal status, the variability in strength and size of cannabis cigarettes (joints), and the fact that most cannabis users also smoke tobacco, making the effects difficult to separate. Despite these difficulties, the available evidence indicates that smoking cannabis causes bronchitis and is associated with changes in lung function. The pattern of effects is surprisingly different from that of tobacco. Whereas smoking cannabis appears to increase the risk of severe bronchitis at quite low exposure, there is no convincing evidence that this leads to chronic obstructive pulmonary disease. Instead, cannabis use is associated with increased central airway resistance, lung hyperinflation and higher vital capacity with little evidence of airflow obstruction or impairment of gas transfer. There are numerous reports of severe bullous lung disease and pneumothorax among heavy cannabis users, but convincing epidemiological data of an increased risk of emphysema or alveolar destruction are lacking. An association between cannabis and lung cancer remains unproven, with studies providing conflicting findings.
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Affiliation(s)
- Kathryn Gracie
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Li H, Zeng Z, Cheng J, Hu G, Li Y, Wei L, Zhou Y, Ran P. Prognostic Role of NT-proBNP for in-Hospital and 1-Year Mortality in Patients with Acute Exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:57-67. [PMID: 32021144 PMCID: PMC6955621 DOI: 10.2147/copd.s231808] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023] Open
Abstract
Background and objective The association between N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations and in-hospital and 1-year mortality in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients is largely unknown. Our objective was to explore the usefulness of NT-proBNP concentrations in AECOPD patients as a prognostic marker for in-hospital and 1-year mortality. Methods NT-proBNP levels were measured in patients upon admission and laboratory and clinical data were also recorded. The cut-point for the NT-proBNP concentration level for in-hospital death was obtained using the receiver operating characteristic (ROC) curve. Univariate and multivariate logistic regression and Cox regression were used in the analyses of factors of in-hospital and 1-year mortality. Results A total of 429 patients were enrolled. Twenty-nine patients died during hospitalization and 59 patients died during the 1-year follow-up. Patients who died in-hospital compared with those in-hospital survivors were older (80.14±6.56 vs 75.93±9.45 years, p=0.003), had a higher percentage of congestive heart failure (65.52% vs 33.75%, p<0.001), had higher NT-proBNP levels (5767.00 (1372.50–12,887.00) vs 236.25 (80.03–1074.75) ng/L, p<0.001), higher neutrophil counts (10.52±5.82 vs 7.70±4.31, p=0.016), higher D-dimer levels (1231.62±1921.29 vs 490.11±830.19, p=0.048), higher blood urea nitrogen levels (9.91±6.33 vs 6.51±4.01 mmol/L, p=0.001), a lower body mass index (19.49±3.57 vs 22.19±4.76, p=0.003), and higher hemoglobin levels (122.34±25.36 vs 130.57±19.63, p=0.034). The area under the ROC curve (AUC) for NT-proBNP concentration was 0.88 (95% confidence interval [CI], 0.84–0.93). NT-proBNP concentrations ≥551.35 ng/L were an independent prognostic factor for both in-hospital and 1-year mortality after adjustment for relative risk (RR) (RR=29.54, 95% CI 3.04–286.63, p=0.004 for the multivariate logistic regression analysis) and hazard ratio (HR) (HR=4.47, 95% CI, 2.38–8.41, p <0.001 for the multivariate cox regression analysis). Conclusion NT-proBNP was a strong and independent predictor of in-hospital and 1-year mortality in AECOPD patients.
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Affiliation(s)
- Haiqing Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zixiong Zeng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Juan Cheng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Guoping Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yuqun Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Liping Wei
- Department of Respiratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yumin Zhou
- Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Pixin Ran
- Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
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5
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Shafuddin E, Chang CL, Cooray M, McAnulty KA, Karalus NC, Lee MHS, Hancox RJ. Cardiac dysfunction in exacerbations of chronic obstructive pulmonary disease is often not detected by electrocardiogram and chest radiographs. Intern Med J 2019; 49:761-769. [DOI: 10.1111/imj.14144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/02/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Manisha Cooray
- School of MedicineUniversity of Auckland Auckland New Zealand
| | - Kim A. McAnulty
- Department of RadiologyWaikato Hospital Hamilton New Zealand
| | - Noel C. Karalus
- Department of Respiratory MedicineWaikato Hospital Hamilton New Zealand
| | - Marcus H. S. Lee
- Department of CardiologyWaikato Hospital Hamilton New Zealand
- Department of General MedicineWhangarei Hospital Whangarei New Zealand
| | - Robert J. Hancox
- Department of Respiratory MedicineWaikato Hospital Hamilton New Zealand
- Department of Preventive and Social MedicineUniversity of Otago Dunedin New Zealand
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N-Terminal Prohormone of Brain Natriuretic Peptide (NT-proBNP) as a Diagnostic Biomarker of Left Ventricular Systolic Dysfunction in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Lung 2018; 196:583-590. [DOI: 10.1007/s00408-018-0137-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 06/24/2018] [Indexed: 12/28/2022]
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Hawkins NM, Khosla A, Virani SA, McMurray JJV, FitzGerald JM. B-type natriuretic peptides in chronic obstructive pulmonary disease: a systematic review. BMC Pulm Med 2017; 17:11. [PMID: 28073350 PMCID: PMC5223538 DOI: 10.1186/s12890-016-0345-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/09/2016] [Indexed: 12/29/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) have increased cardiovascular risk. Natriuretic peptides (NP) in other populations are useful in identifying cardiovascular disease, stratifying risk, and guiding therapy. Methods We performed a systematic literature review to examine NP in COPD, utilising Medline, EMBASE, and the Cochrane Library. Results Fifty one studies were identified. NP levels were lower in stable compared to exacerbation of COPD, and significantly increased with concomitant left ventricular systolic dysfunction or cor pulmonale. Elevation occurred in 16 to 60% of exacerbations and persisted in approximately one half of patients at discharge. Cardiovascular comorbidities were associated with increased levels. Levels consistently correlated with pulmonary artery pressure and left ventricular ejection fraction, but not pulmonary function or oxygen saturation. NP demonstrated high negative predictive values (0.80 to 0.98) to exclude left ventricular dysfunction in both stable and exacerbation of COPD, but relatively low positive predictive values. NP elevation predicted early adverse outcomes, but the association with long term mortality was inconsistent. Conclusion NP reflect diverse aspects of the cardiopulmonary continuum which limits utility when applied in isolation. Strategies integrating NP with additional variables, biomarkers and imaging require further investigation.
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Affiliation(s)
- Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.
| | - Amit Khosla
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - John J V McMurray
- Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - J Mark FitzGerald
- Division of Respiratory Medicine, University of British Columbia and Institute for Heart and Lung Health, Vancouver, Canada
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8
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Nazemiyeh M, Sharifi A, Amiran F, Pourafkari L, Taban Sadeghi M, Namdar H, Abbasnezhad M. Relationship Between Prohormone Brain Natriuretic Peptide (NT-proBNP) Level and Severity of Pulmonary Dysfunction in Patients With Chronic Congestive Heart Failure. J Cardiovasc Thorac Res 2015; 7:24-7. [PMID: 25859312 PMCID: PMC4378671 DOI: 10.15171/jcvtr.2015.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 02/14/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction: Congestive heart failure (CHF) is a common disease and its prevalence is increasing in industrialized countries. NT-proBNP measurement is an established diagnostic test for diagnosis of CHF in patients who present to emergency room with acute dyspnea. The primary object of this study was to determine the relationship between levels of brain natriuretic peptide precursor and severity of lung function impairment in patients with chronic CHF.
Methods: This cross-sectional and analytical study that performed in Tuberculosis and Lung Disease Research Center of Tabriz University of Medical Sciences on 95 patients with chronic heart failure, and relation between NT-proBNP levels and pulmonary function parameters were examined.
Results: Sixty-four patients were male and 31 were female. The average age of male and females was 62.90 ± 11.54 and 61.61 ± 11.98 years, respectively. A significant inverse linear correlation was found between NT-proBNP and FEV1 (P < 0.001, r = -0.367), FVC (P < 0.001, r = -0.444), TLC (P = 0.022, r = -0.238), maximal midexpiratory flow (MMEF) (P = 0.047, r = -0.207) and left ventricular ejection fraction (LVEF) (P < 0.001, r = -0.461). A significant positive linear correlation was found between NT-proBNP and FEV1/FVC (P = 0.013, r = 0.257), RV/TLC (P = 0.003, r=0.303) and 5 Hz Raw (r = 0.231, P = 0.024).
Conclusion: This study showed that, both restrictive and obstructive ventilator impairments can occur in chronic CHF and as NT-proBNP increases appropriate to hemodynamic deterioration, pulmonary dysfunction increases.
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Affiliation(s)
- Masoud Nazemiyeh
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Sharifi
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Amiran
- Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hossein Namdar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Abbasnezhad
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Laratta CR, van Eeden S. Acute exacerbation of chronic obstructive pulmonary disease: cardiovascular links. BIOMED RESEARCH INTERNATIONAL 2014; 2014:528789. [PMID: 24724085 PMCID: PMC3958649 DOI: 10.1155/2014/528789] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/16/2013] [Indexed: 01/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease resulting from exposure to cigarette smoke, noxious gases, particulate matter, and air pollutants. COPD is exacerbated by acute inflammatory insults such as lung infections (viral and bacterial) and air pollutants which further accelerate the steady decline in lung function. The chronic inflammatory process in the lung contributes to the extrapulmonary manifestations of COPD which are predominantly cardiovascular in nature. Here we review the significant burden of cardiovascular disease in COPD and discuss the clinical and pathological links between acute exacerbations of COPD and cardiovascular disease.
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Affiliation(s)
- Cheryl R Laratta
- Department of Medicine, University of Alberta, Edmonton, AB, Canada ; UBC James Hogg Research Center, Institute for Heart and Lung Health, University of British Columbia, Canada
| | - Stephan van Eeden
- UBC James Hogg Research Center, Institute for Heart and Lung Health, University of British Columbia, Canada ; Respiratory Division, Department of Medicine, St. Paul's Hospital, Vancouver, BC, Canada
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