COPD 患者无低氧血症时的左心室肥厚：房间里的大象？

Left ventricular hypertrophy in COPD without hypoxemia: the elephant in the room?

机构信息

Centre for Cardiovascular and Lung Biology, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland.

出版信息

Chest. 2013 Jan;143(1):91-97. doi: 10.1378/chest.12-0775.

DOI:10.1378/chest.12-0775

PMID:22797769

Abstract

BACKGROUND

COPD is associated with significant cardiovascular mortality. Left ventricular hypertrophy (LVH) is a pivotal cardiovascular risk factor. The prevalence of LVH in COPD is currently unknown.

METHODS

We performed a pilot study of 93 normoxemic patients with COPD and 34 control subjects. Patients underwent echocardiography to measure left ventricular (LV) dimensions, ECG, measurement of serum B-type natriuretic peptide (BNP) levels, and 24-h BP recording. Spirometry and oxygen saturations were also recorded.

RESULTS

The oxygen saturations of patients with COPD were normal, at 96.5% (95% CI, 96.1%-97.0%), with a mean FEV(1) of 70.0% predicted (95% CI, 65.2%-74.8%). A total of 30.1% of patients with COPD met the echocardiographic criteria for LVH based on LV mass index, with more LVH in female patients than in male patients (43.2% vs 21.4%, P = .02). The LV mass index in patients with COPD was 96.2 g/m(2) (95% CI, 90.1-102.7 g/m(2)) vs 82.9 g/m(2) (95% CI, 75.8-90.6 g/m(2)) in control subjects ( P = .017). The LV mass index remained high in patients with COPD in the absence of a hypertension history (94.5 g/m(2) vs 79.9 g/m(2), P = .015) and with 24-h systolic BP <135 mm Hg (96.7 g/m(2) vs 82.5 g/m(2), P = .024). The LV ejection fraction (mean = 63.4%) and BNP (mean = 28.7 pg/mL) were normal in patients with COPD. The mean 24-h BP was normal in patients with COPD, at 125/72 mm Hg. ECG was less sensitive for detecting LVH than was echocardiography.

CONCLUSION

LVH with normal LV ejection fraction and BNP levels was present in a significant proportion of normotensive, normoxemic patients with COPD, especially female patients. Clinical trials are, therefore, indicated to evaluate treatments to regress LVH in patients with COPD.

摘要

背景

COPD 与显著的心血管死亡率相关。左心室肥厚（LVH）是一个关键的心血管危险因素。目前尚不清楚 COPD 患者中 LVH 的患病率。

方法

我们对 93 名无低氧血症的 COPD 患者和 34 名对照者进行了一项试点研究。患者接受超声心动图检查以测量左心室（LV）的大小、心电图、测量血清 B 型利钠肽（BNP）水平以及 24 小时血压记录。还记录了肺量计和血氧饱和度。

结果

COPD 患者的血氧饱和度正常，为 96.5%（95%CI，96.1%-97.0%），平均 FEV（1）为 70.0%预计值（95%CI，65.2%-74.8%）。根据 LV 质量指数，30.1%的 COPD 患者符合 LVH 的超声心动图标准，女性患者的 LVH 多于男性患者（43.2%比 21.4%，P=0.02）。COPD 患者的 LV 质量指数为 96.2 g/m（2）（95%CI，90.1-102.7 g/m（2）），而对照组为 82.9 g/m（2）（95%CI，75.8-90.6 g/m（2））（P=0.017）。在没有高血压病史的情况下（94.5 g/m（2）比 79.9 g/m（2），P=0.015）和 24 小时收缩压<135 mm Hg 的情况下（96.7 g/m（2）比 82.5 g/m（2），P=0.024），COPD 患者的 LV 质量指数仍然很高。COPD 患者的 LV 射血分数（平均值=63.4%）和 BNP（平均值=28.7 pg/mL）正常。COPD 患者的平均 24 小时血压正常，为 125/72 mm Hg。心电图对 LVH 的检测不如超声心动图敏感。