Co-existence of COPD and left ventricular dysfunction in vascular surgery patients

Background: The co-existence between chronic obstructive pulmonary disease (COPD) and heart failure has been previously described. However, the co-existence between COPD and subclinical left ventricular (LV) dysfunction, without the presence of heart failure symptoms, is less well understood. This study determined the relationship and clinical relevance of COPD and subclinical LV dysfunction in vascular surgery patients. Methods: 1005 consecutive vascular surgery patients were included in which COPD was determined using spirometry and LV function using echocardiography. Mild COPD was defined as FEV1≥ 80% of predicted + FEV1/FVC-ratio < 0.70. Moderate/severe COPD was defined as FEV1< 80% of predicted + FEV1/FVC-ratio < 0.70. Systolic LV dysfunction was defined as LV ejection fraction <50% and diastolic LV dysfunction was diagnosed based on E/A-ratio, pulmonary vein flow and deceleration time. Multivariate regression analyses were used to evaluate the impact of COPD and LV dysfunction on all-cause mortality. The mean follow-up time was 2.2 ± 1.8 years. Results: Both, mild and moderate/severe COPD were associated with increased risk for subclinical LV dysfunction with odds ratio of 1.6 (95%-CI = 1.1-2.3) and 1.7 (95%-CI = 1.2-2.4), respectively. Mild- or moderate/severe COPD in combination with LV dysfunction was associated with increased risk for all-cause mortality (mild: hazard ratio 1.7; 95%-CI = 1.1-3.6, moderate/severe: hazard ratio 2.5; 95%-CI = 1.5-4.7). Conclusions: COPD was associated with increased risk for subclinical LV dysfunction. COPD + subclinical LV dysfunction was associated with increased risk for all-cause mortality compared to patients with COPD + normal LV function. Echocardiography may be useful to detect subclinical cardiovascular disease and risk-stratify COPD patients undergoing vascular surgery.

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