Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy.
Department of Health Sciences, University Magna Graecia, Catanzaro, Italy.
Eur J Clin Invest. 2023 Feb;53(2):e13887. doi: 10.1111/eci.13887. Epub 2022 Oct 17.
Lung hyperinflation and systemic inflammation are currently believed to be the most important causes of right heart alterations in chronic obstructive pulmonary disease (COPD) patients. A multicentre observational study was performed to assess the morphological and functional parameters of right ventricle (RV) in COPD subjects, as well as to evaluate the potential prognostic impact on the development of major cardiovascular adverse events (MACEs).
For this retrospective study, from 1 January 2010 to 31 December 2021, we enrolled COPD patients on the basis of their airflow limitation. In particular, we selected subjects spanning across GOLD 1 and 2 functional stages. Clinical, laboratory and functional parameters were collected at baseline. Echocardiography was routinely performed in all COPD patients. RV dysfunction was defined on the basis of tricuspid annular plane systolic excursion (TAPSE) values. MACE occurrence (non-fatal ischemic stroke, non-fatal myocardial infarction, cardiac revascularization or coronary bypass surgery and cardiovascular death) was evaluated during a median follow-up of 55 (36-72) months.
Among the 749 enrolled patients, 408 subjects had a TAPSE value ≥20 mm, while the remaining 341 had a TAPSE value <20 mm. In patients with TAPSE ≥20 mm the observed MACEs were 1.9 events/100 patient-year, while in the group with a worse right heart function there were 4.2 events/100 patient-year (p < .0001). The multivariate analysis model confirmed the association between RV dysfunction and MACE. Indeed, a 1-mm increase in TAPSE value and the intake of long-acting β -receptor agonists (LABA)/long-acting muscarinic antagonist (LAMA) inhaled therapy were protective factors for the onset of MACE, while the presence of diabetes mellitus and high values of both uric acid (UA) and systolic pulmonary arterial pressure (S-PAP) enhanced the risk of MACE in study participants.
The results of this study showed that in patients with mild COPD there is an association between right heart dysfunction and the risk of MACE during follow-up.
目前认为，肺气肿和全身炎症是慢性阻塞性肺疾病（COPD）患者右心改变的最重要原因。一项多中心观察性研究旨在评估 COPD 患者右心室（RV）的形态和功能参数，并评估其对主要心血管不良事件（MACE）发展的潜在预后影响。
本回顾性研究纳入了 2010 年 1 月 1 日至 2021 年 12 月 31 日期间基于气流受限的 COPD 患者。具体来说，我们选择了跨越 GOLD 1 和 2 功能阶段的患者。在基线时收集了临床、实验室和功能参数。所有 COPD 患者均常规进行超声心动图检查。RV 功能障碍定义为三尖瓣环平面收缩期位移（TAPSE）值。在中位随访 55（36-72）个月期间，评估了 MACE 的发生（非致死性缺血性卒中、非致死性心肌梗死、心脏血运重建或冠状动脉旁路移植术和心血管死亡）。
在纳入的 749 名患者中，408 名患者的 TAPSE 值≥20mm，而其余 341 名患者的 TAPSE 值<20mm。在 TAPSE 值≥20mm 的患者中，观察到的 MACE 为 1.9 例/100 患者年，而在右心功能较差的患者中为 4.2 例/100 患者年（p<0.0001）。多变量分析模型证实了 RV 功能障碍与 MACE 之间的关联。事实上，TAPSE 值增加 1mm 以及长效β受体激动剂（LABA）/长效抗毒蕈碱药物（LAMA）吸入治疗与 MACE 的发生呈保护关系，而糖尿病和尿酸（UA）和收缩期肺动脉压（S-PAP）值较高则增加了研究参与者发生 MACE 的风险。
本研究结果表明，在轻度 COPD 患者中，右心功能障碍与随访期间 MACE 风险之间存在关联。
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