COPD

Use CT to look for severe cardiac disease in patients with acute exacerbations of COPD: study


More than 40% of patients with acute exacerbations of COPD also have severe undiagnosed cardiac disease that is potentially detectable by CT imaging, an Australian study has shown.

Researchers at Monash Lung and Sleep found severe coronary artery disease (CAD) in about one-third of 148 patients hospitalised for acute exacerbations of COPD.

Using dynamic cardiopulmonary CT to investigate coronary artery calcium burden and heart failure with reduced ejection fraction (HFrEF) they also detected left ventricular systolic dysfunction  in 8% of patients and right ventricular systolic dysfunction was present in 12% of patients.

These severe cardiac pathologies would not have been detected by standard hospital care assessments for patients with COPD, with cardiac biomarkers such as troponin and brain natriuretic peptide (BNP) performing relatively poorly to diagnose severe CAD and HFrEF, the study investigators said.

It was therefore not surprising that undertreatment with cardiovascular disease-modifying agents was common, they wrote in ERJ Open Research.

Of those patients with severe CAD, only 39% were prescribed an antiplatelet agent, and 53% received a statin. For the patients identified with HFrEF, less than half received angiotensin blockers, beta blockers or antimineralocorticoids.

In their paper they said that cardiac conditions were known to commonly co-exist with COPD, but current treatment paradigms were predominantly aimed at pulmonary, rather than cardiac parameters. It was also difficult to accurately differentiate between pulmonary and cardiac diagnoses during investigation and management of acute exacerbations of COPD, they noted.

“Clinical features such as dyspnoea and chest discomfort overlap and although evidence of missed ischaemic events can be found on ECGs, in the acute setting, these remain mostly nonspecific,” they wrote.

Standard cardiac imaging modalities such as transthoracic echocardiography had substantive limitations during acute exacerbations of COPD that rendered them inaccurate or impractical, they added.

In contrast, CT imaging had the potential enable rapid assessment of key cardiac parameters when used in a  dynamic cardiopulmonary CT protocol with a single breath hold., they asserted.

Offering substantial pragmatic advantages in comparison with other cardiac imaging modalities and being able to detect 40% of patients having severe, but treatable cardiac disease, the CT “has potential to guide treatment and improve prognosis in people with COPD,” they concluded.

“Taken together these findings imply that targeted disease finding in hospitalised AECOPD may aid diagnosis, treatment and prevention of future cardiac morbidity and mortality.

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