Oxidative Stress and Inflammatory Cytokines as Drivers of Cardiac Remodeling in COPD Patients

Figures

• 

  Figure 1. Proposed pathophysiological mechanisms linking oxidative stress and systemic inflammation to cardiac remodeling in COPD. Cigarette smoke and environmental pollutants promote oxidative stress and the activation of inflammatory pathways, leading to increased release of pro-inflammatory cytokines. The resulting systemic inflammation, endothelial dysfunction, oxidative–antioxidant imbalance, and autonomic nervous system dysregulation may contribute to both electrical and structural cardiac remodeling, ultimately increasing the risk of arrhythmias and cardiovascular events in patients with COPD. Abbreviations: COPD, chronic obstructive pulmonary disease; ROS, reactive oxygen species; RNS, reactive nitrogen species; IL, interleukin; TNF-α, tumor necrosis factor α; QTc, corrected QT interval.

• 

  Figure 2. Multimodal cardiopulmonary assessment performed in the study. The integrated evaluation included inflammatory biomarker assessment, pulmonary function testing, 24 h Holter ECG monitoring, and transthoracic echocardiography, providing a comprehensive characterization of cardiovascular involvement in patients with COPD.

• 

  Figure 3. ROC analysis—sinus rhythm abnormalities.

• 

  Figure 4. ROC analysis—atrial fibrillation/atrial flutter.

• 

  Figure 5. ROC analysis—VPCs.

• 

  Figure 6. ROC analysis—isolated supraventricular ectopic beats.

• 

  Figure 7. ROC analysis—PSVT.

• 

  Figure 8. Correlations between inflammatory biomarkers and electrocardiographic parameters. (A) IL-8 and ST-segment depression; (B) NLR and maximum QT interval; (C) MLR and ST-segment depression; (D) MLR and HRV; (E) LHR and minimum QT interval; (F) PLR and HRV; (G) LHR and maximum QT interval; and (H) fibrinogen and rMSSD. Regression lines illustrate the direction of the observed associations. Abbreviations: NLR, neutrophil-to-lymphocyte ratio; MLR, monocyte-to-lymphocyte ratio; LHR, lymphocyte-to-HDL ratio; PLR, platelet-to-lymphocyte ratio; HRV, heart rate variability; rMSSD, root mean square of successive differences.