The following is a summary of “Influence of heart failure (HF) comorbidity in chronic obstructive pulmonary disease (COPD) and isolated forms of HF and COPD on cardiovascular function during hospitalization,” published in the July 2024 issue of Pulmonology by Schafauser et al.
The coexistence of chronic obstructive pulmonary disease (COPD) and heart failure (HF) exacerbates systemic inflammation, myocardial injury, and arterial stiffness, profoundly influencing cardiovascular risk and prognosis. This study aimed to evaluate the cardiovascular profile of patients hospitalized with exacerbations of COPD (ECOPD) in conjunction with HF compared to those with isolated diseases.
This cross-sectional study enrolled patients diagnosed with ECOPD and decompensated HF within 24 to 48 hours of hospital admission. Assessments included endothelial function measured by brachial artery flow-mediated vasodilation (FMD), hemodynamic analysis via pulse wave analysis, arterial stiffness assessed by carotid-femoral pulse wave velocity (cfPWV), and cardiac autonomic modulation (CAM) evaluated through heart rate variability (HRV).
The mean FMD was significantly impaired across all groups, indicating endothelial dysfunction: COPD (5.47%, 95% CI 3.96–6.91), COPD-HF (2.66%, 95% CI 0.09–3.48), and HF (4.60%, 95% CI 2.30–6.43) (p<0.01). Patients with COPD-HF exhibited worse FMD compared to isolated diseases. Arterial stiffness, reflected by augmentation index (AIx) and cfPWV, was also significantly higher in the COPD-HF group compared to isolated COPD or HF (p<0.01). Moreover, sympathetic nervous system activation, indicated by HRV parameters (PNS and SNS), was markedly increased in patients with COPD-HF compared to those with isolated diseases (p<0.01). Measures of CAM (rMSSD, NN50, pNN50, TINN) further underscored worse autonomic modulation in the COPD-HF group.
Hospitalized patients with COPD and HF experience more severe vascular dysfunction and impaired cardiac autonomic modulation compared to those with isolated diseases. These findings highlight the critical need for comprehensive cardiovascular assessment and tailored management strategies to address the compounded cardiovascular effects of COPD and HF comorbidity during hospitalization.
Source: sciencedirect.com/science/article/abs/pii/S0954611124002063