Program Development Center, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
Am J Cardiol. 2011 Dec 1;108(11):1669-74. doi: 10.1016/j.amjcard.2011.07.027.
Cardiovascular disease is common in patients with chronic obstructive pulmonary disease (COPD) but often remains unrecognized. Ischemic electrocardiographic (ECG) changes are associated with a higher risk of dying from coronary heart disease but have never been systematically evaluated in COPD. Also, their relation to clinical outcome has not been studied. We aimed to determine the frequency of ischemic ECG changes and its relevance in relation to clinical outcome and predictors of impaired survival in patients with COPD. Clinical characteristics, pulmonary function, and co-morbidities were assessed in 536 patients with COPD during baseline assessment of a comprehensive pulmonary rehabilitation program. Moreover, electrocardiograms at rest were obtained in all patients. All electrocardiograms were scored independently by 2 cardiologists using the Minnesota scoring system. Major or minor Q or QS pattern, ST junction and segment depression, T-wave items, or left bundle branch block were considered ischemic ECG changes. One hundred thirteen patients (21%) had ischemic ECG changes. Moreover, 42 of 293 patients (14%) without self-reported cardiovascular co-morbidities had ischemic ECG changes. In addition, patients with ischemic ECG changes had higher dyspnea grades (Modified Medical Research Council (mMRC) 2.9 ± 1.1 vs 2.6 ± 1.1, p = 0.032), worse exercise performance (6-minute walking distance 387 ± 126 vs 425 ± 126 m, p = 0.004), more systemic inflammation (high-sensitivity C-reactive protein 11.2 ± 16.2 vs 7.9 ± 10.7 mmol/l, p = 0.01), higher scores on the Charlson Co-morbidity Index (1.8 ± 0.9 vs 1.5 ± 0.8 points), and higher scores BODE (5.3 ± 3.7 vs 4.5 ± 3.4 points, p = 0.033) and on ADO indexes (5.2 ± 1.7 vs 4.8 ± 1.7 points, p = 0.029) compared to patients without ischemic ECG changes, whereas forced expiratory volume in the first second was similar (40.8 ± 15.2% vs 42.6% ± 15.9%, p = 0.30). In conclusion, ischemic ECG changes are common in patients with COPD and associated with poor clinical outcome irrespective of forced expiratory volume in the first second. These results suggest an important role for cardiovascular disease in impaired survival in these patients.
心血管疾病在慢性阻塞性肺疾病（COPD）患者中很常见，但常常未被识别。缺血性心电图（ECG）改变与冠心病死亡风险增加相关，但从未在 COPD 中进行过系统评估。此外，其与临床结局的关系尚未被研究。我们旨在确定缺血性 ECG 改变的频率及其与 COPD 患者临床结局和生存预测因子的相关性。在综合肺康复计划的基线评估期间，对 536 例 COPD 患者进行了临床特征、肺功能和合并症评估。此外，所有患者均获得静息心电图。两位心脏病专家使用明尼苏达州评分系统独立对所有心电图进行评分。主要或次要 Q 或 QS 模式、ST 交界和段压低、T 波项目或左束支传导阻滞被认为是缺血性 ECG 改变。113 例（21%）患者存在缺血性 ECG 改变。此外，293 例无自述心血管合并症的患者中有 42 例（14%）存在缺血性 ECG 改变。此外，存在缺血性 ECG 改变的患者呼吸困难程度更高（改良医学研究委员会（mMRC）评分 2.9 ± 1.1 与 2.6 ± 1.1，p = 0.032），运动表现更差（6 分钟步行距离 387 ± 126 与 425 ± 126 m，p = 0.004），全身炎症反应更明显（高敏 C 反应蛋白 11.2 ± 16.2 与 7.9 ± 10.7 mmol/L，p = 0.01），Charlson 合并症指数评分更高（1.8 ± 0.9 与 1.5 ± 0.8 分），BODE 评分更高（5.3 ± 3.7 与 4.5 ± 3.4 分，p = 0.033）和 ADO 指数评分更高（5.2 ± 1.7 与 4.8 ± 1.7 分，p = 0.029），而第一秒用力呼气量（FEV1）相似（40.8 ± 15.2%与 42.6% ± 15.9%，p = 0.30）。总之，缺血性 ECG 改变在 COPD 患者中很常见，与第一秒用力呼气量无关，与不良临床结局相关。这些结果提示心血管疾病在这些患者的生存受损中起重要作用。
