Heart problems in COPD patients increase mortality risk – Important distinctions for targeted treatments

DZL scientists identified two main types of cardiac impairment in COPD patients, which have different effects on mortality risk. A precise diagnosis is therefore crucial for the development of targeted treatment strategies.

 

A new study, conducted by a research team from all five sites of the German Center for Lung Research (DZL), provides important insights into the heart-related health of patients with chronic obstructive pulmonary disease (COPD). Under the leadership of DZL scientist PD Dr. Benjamin Waschki and first author Dr. Mustafa Abdo (LungenClinic Grosshansdorf, ARCN), it was shown that heart problems in COPD patients are associated with an increased mortality risk. It is particularly important to differentiate between two main causes of these heart problems: One is heart failure with preserved ejection fraction (HFpEF) and the other is reduced blood return to the heart, indicated by a smaller size of the left ventricle.

In the comprehensive study of COPD patients from the COSYCONET cohort, transthoracic echocardiography was used to determine whether they had a small left ventricle (LV) or characteristics of heart failure with preserved ejection fraction (HFpEF). HFpEF is a heart condition in which the heart ejects blood normally but has difficulty filling with enough blood, leading to symptoms such as shortness of breath and fatigue. In the case of a small left ventricle, the heart cannot fill with enough blood, which can lead to reduced cardiac output and heart failure. The main focus of the study was on mortality after four and a half years.

Of over 1,700 COPD patients, eight percent had a small LV, 16 percent had HFpEF features and 45 percent had normal cardiac ultrasound. Patients with small LV or HFpEF features had a higher mortality rate than those with normal ultrasound results. The risk of death was about 2.75 times higher in patients with small LV and about 2.16 times higher in those with HFpEF features. Distinguishing between these two heart problems is crucial as they have different causes and treatment options.

Comprehensive diagnosis to identify high-risk patients

The study used comprehensive diagnostic methods, such as ultrasound and the measurement of heart and lung markers, to find out which patients have a higher risk of premature mortality. These findings highlight the need to accurately diagnose and treat heart problems in COPD patients. While HFpEF is often treated with medications that regulate blood pressure and cardiac workload, patients with a small left ventricle may benefit from therapies that reduce lung hyperinflation. In hyperinflation, the lungs expand beyond their normal size because air is trapped inside and cannot escape. It causes symptoms such as difficulty to breath in and shortness of breath. Treatment includes specialized medication, breathing exercises or oxygen therapy.

Targeted management of the various heart problems could improve the life expectancy of these patients and significantly reduce the impact of heart problems on their health.

 

Quelle: DZL-Website [in German]

Publication: Abdo M, Watz H, Alter P, Kahnert K, Trudzinski F, Groth EE, Claussen M, Kirsten AM, Welte T, Jörres RA, Vogelmeier CF, Bals R, Rabe KF, Waschki B. Characterization and Mortality Risk of Impaired Left Ventricular Filling in COPD. Am J Respir Crit Care Med. 2024 Jul 10. Link to the article

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