Key result
Right ventricular dysfunction was associated with a higher incidence of MACE (4.2 vs 1.9 events/100 patient-years), and a 1-mm increase in TAPSE independently reduced the risk of MACE by 33%.
Why the study?
Lung hyperinflation and systemic inflammation are believed to cause right heart alterations in COPD, but the prognostic impact of right ventricular morphological and functional parameters on MACE required evaluation.
Does right ventricular dysfunction increase the risk of major cardiovascular adverse events in patients with mild COPD?
Cohort (n=749)
Yes
Does right ventricular dysfunction increase the risk of major cardiovascular adverse events in patients with mild COPD?
Hazard Ratio: 0.665 (95% CI 0.562–0.942)
Absolute Event Rate: 4.2% vs 1.9%
p-value: p=<0.0001
Right ventricular dysfunction, even in early-stage COPD, is strongly associated with an increased incidence of major cardiovascular adverse events.
RV dysfunction may flag higher MACE risk in mild COPD; leaves open whether TAPSE-guided strategies improve outcomes.
Background 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). Methods 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. Results 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 2 ‐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. Conclusions 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.
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Armentaro et al. (2022) conducted a cohort in mild COPD (GOLD stages 1 and 2) (n=749). Right ventricular dysfunction (TAPSE <20 mm) vs. Normal right ventricular function (TAPSE ≥20 mm) was evaluated on Major cardiovascular adverse events (MACE: non-fatal ischemic stroke, non-fatal MI, coronary revascularization, cardiovascular death) (HR 0.665 (per 1-mm increase in TAPSE), 95% CI 0.562-0.942, p=<0.0001). Right ventricular dysfunction was associated with a higher incidence of MACE (4.2 vs 1.9 events/100 patient-years), and a 1-mm increase in TAPSE independently reduced the risk of MACE by 33%.
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