慢性阻塞性肺疾病中基于心电图的不良心肺事件风险因素及治疗结果

ECG-based risk factors for adverse cardiopulmonary events and treatment outcomes in COPD.

作者信息

Wade R Chad, Martinez Fernando J, Criner Gerard J, Tombs Lee, Lipson David A, Halpin David M G, Han MeiLan K, Singh Dave, Wise Robert A, Kalhan Ravi, Dransfield Mark T

机构信息

Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.

Division of Pulmonology and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA.

出版信息

Eur Respir J. 2025 Feb 6;65(2). doi: 10.1183/13993003.00171-2024. Print 2025 Feb.

BACKGROUND

COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two ECG markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD.

METHODS

This was a analysis of the IMPACT trial. Outcomes included odds (odds ratio, 95% confidence intervals) of adverse cardiopulmonary events stratified by CIIS threshold (<20 ≥20) and P pulmonale (baseline). Events included all-cause death, hospitalisation or death, cardiovascular adverse event of special interest, severe COPD exacerbations, and moderate/severe COPD exacerbations. We also assessed the effects of fluticasone furoate/umeclidinium/vilanterol fluticasone furoate/vilanterol or umeclidinium/vilanterol based on CIIS and P pulmonale.

RESULTS

We included 9448 patients. Patients with CIIS ≥20 ( CIIS <20) had greater odds of all-cause death (OR 1.73, 95% CI 1.27-2.37, p<0.001), hospitalisation or death (OR 1.33, 95% CI 1.17-1.50, p<0.001), cardiovascular adverse event of special interest (OR 1.27, 95% CI 1.08-1.48, p<0.005), severe COPD exacerbations (OR 1.41, 95% CI 1.21-1.64, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.13-1.40, p<0.001). Patients with P pulmonale ( without) had greater odds of all-cause death (OR 2.25, 95% CI 1.54-3.29, p<0.001), hospitalisation or death (OR 1.51, 95% CI 1.28-1.79, p<0.001), severe COPD exacerbations (OR 2.00, 95% CI 1.65-2.41, p<0.001) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.08-1.46, p<0.001). A combined model demonstrated that patients with CIIS ≥20 and P pulmonale had increased risk of all-cause death (OR 3.38, 95% CI 1.23-9.30, p=0.019), hospitalisation or death (OR 1.61, 95% CI 1.14-2.22, p=0.004) and rate of severe COPD exacerbations (OR 1.89, 95% CI 1.22-2.91, p=0.004) and moderate/severe COPD exacerbations (OR 1.25, 95% CI 1.00-1.56, p=0.046). The risk of all-cause death and cardiovascular adverse events of special interest was reduced with fluticasone furoate/umeclidinium/vilanterol umeclidinium/vilanterol in patients with CIIS ≥20, but not CIIS <20.

CONCLUSIONS

These findings suggest the potential clinical relevance of CIIS and P pulmonale as risk indicators for adverse cardiopulmonary events in COPD.

背景

慢性阻塞性肺疾病（COPD）死亡率高，合并心血管疾病时情况更复杂。我们研究了两种心电图标志物，即心肌梗死损伤评分（CIIS）和肺型P波，作为COPD患者发生不良心肺事件的预后工具。

方法

这是对IMPACT试验的一项分析。结局包括按CIIS阈值（<20与≥20）和肺型P波（基线）分层的不良心肺事件的比值比（优势比，95%置信区间）。事件包括全因死亡、住院或死亡、特别关注的心血管不良事件、重度COPD急性加重以及中度/重度COPD急性加重。我们还基于CIIS和肺型P波评估了糠酸氟替卡松/乌美溴铵/维兰特罗、糠酸氟替卡松/维兰特罗或乌美溴铵/维兰特罗的效果。

结果

我们纳入了9448例患者。CIIS≥20（与CIIS<20相比）的患者全因死亡（优势比1.73，95%置信区间1.27 - 2.37，p<0.001）、住院或死亡（优势比1.33，95%置信区间1.17 - 1.50，p<0.001）特别关注的心血管不良事件（优势比1.27，95%置信区间1.08 - 1.48，p<0.005）、重度COPD急性加重（优势比1.41，95%置信区间1.21 - 1.64，p<0.001）以及中度/重度COPD急性加重（优势比1.25，95%置信区间1.13 - 1.40，p<0.001）的比值比更高。有肺型P波（与无肺型P波相比）的患者全因死亡（优势比2.25，95%置信区间1.54 - 3.29，p<0.001）、住院或死亡（优势比1.51，95%置信区间1.28 - 1.79，p<0.001）、重度COPD急性加重（优势比2.00，95%置信区间1.65 - 2.41，p<0.001）以及中度/重度COPD急性加重（优势比1.25，95%置信区间1.08 - 1.46，p<0.001）的比值比更高。一个联合模型表明，CIIS≥20且有肺型P波的患者全因死亡（优势比3.38，95%置信区间1.23 - 9.30，p = 0.019）、住院或死亡（优势比1.61，95%置信区间1.14 - 2.22，p = 0.004）以及重度COPD急性加重率（优势比1.89，95%置信区间1.22 - 2.91，p = 0.004）和中度/重度COPD急性加重（优势比1.25，95%置信区间1.00 - 1.56，p = 0.046）的风险增加。在CIIS≥20但不是CIIS<20的患者中，糠酸氟替卡松/乌美溴铵/维兰特罗与乌美溴铵/维兰特罗相比，可降低全因死亡和特别关注的心血管不良事件的风险。