Right Heart Dysfunction Linked With Adverse Cardiovascular Events in COPD

A new study suggests that physicians might be able to assess the risk of major adverse cardiovascular events (MACE) in patients with chronic obstructive pulmonary disease (COPD) by analyzing right heart dysfunction.

Cardiovascular disorders are one of the most serious comorbidities for people with COPD. Corresponding author Angela Sciacqua, MD, of the University Magna Græcia of Catanzaro, in Italy, and colleagues, wrote that there is even speculation that COPD itself might be a risk factor for cardiovascular disease.

Currently, Sciacqua and colleagues said lung hyperinflation and systemic inflammation are believed to be the most important causes of the link between COPD and heart disease, and right heart alterations are common in people with COPD.

Given the links between COPD and cardiovascular events, the investigators wanted to know whether the morphological and functional parameters in the right ventricles of patients with early stage COPD might lend insight into the risk that the patient later experiences a MACE.

To find out, they retrospectively examined 749 people who had COPD between 2010 and December 31, 2021. Clinical, laboratory, and functional parameters were all collected at baseline, and the patients underwent routine echocardiography. The authors defined right ventricle dysfunction based on tricuspid annular plane systolic excursion (TAPSE) values.

In results published in the European Journal of Clinical Investigation, the authors described what they found at a median follow-up of 55 months. A majority of the participants in the study (408 people) began with TAPSE values at or above 20 mm, and those patients had an observed MACE rate of 1.9 events per 100 patient-years. In the 341 enrollees with worse right heart function (TAPSE less than 20 mm), the rate of MACEs was 4.2 events per 100 patient years. A multivariate analysis confirmed the link between right ventricle dysfunction and the risk of a MACE.

The investigators further found that increased TAPSE values and the use of long-acting β2-receptor agonists (LABA)/long‐acting muscarinic antagonist (LAMA) therapy protected against MACEs. In fact, just a 1-mm increase in a patient’s TAPSE value led to a drop in the risk of a MACE of 33%.

On the other hand, a diagnosis of diabetes mellitus or high levels of both uric acid and systolic pulmonary arterial pressure increased the risk of a MACE. However, Sciacqua and colleagues said the link between diabetes and MACEs may be a result of other risk factors, rather than something directly related to right ventricle function.

“​​In this regard, it is noteworthy that smoking, diabetes, and other metabolic dysfunctions such as hypercholesterolemia are frequently associated with both COPD and MACE, rather than RV function,” they wrote.

The investigators concluded that their study appears to confirm a link between right heart dysfunction and the risk of major cardiovascular complications among people with COPD. They said the finding ought to inform the way physicians care for patients with COPD.

“In light of these results, it should be essential to implement and optimize a combined therapeutic strategy aimed to improve both cardiac and respiratory function, as well as to evaluate coexisting risk factors, in order to reduce comorbidity and mortality in COPD patients, thus improving the overall prognosis,” they wrote.

Reference

Armentaro G, Pelaia C, Cassano V, et al. Association between right ventricular dysfunction and adverse cardiac events in mild COPD patients. Eur J Clin Invest. Published online October 6, 2022. doi:10.1111/eci.13887