SESSION TYPE: COPD: Severity and Risk Predictors
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: In the contest of a project designed to assess the influence of co-morbidities in the prognosis of COPD, we examined the prevalence of chronic heart failure (CHF), carotid and peripheral arterial disease, metabolic syndrome (MS), in elderly heavy smokers COPD patients.
METHODS: We examined 60 outpatients with confirmed diagnosis of COPD (according to GOLD guidelines), aged ≥65 yrs, ≥20 pack/years, by measuring BODE index, Charlson Comorbidity Index(CCI) and COPD assessment test(CAT). All subjects underwent echocardiography and carotid ultrasonography. LV systolic dysfunction was defined as LV ejection fraction(LVEF) <40%. Tricuspid Annular Plane Systolic Excursion(TAPSE) and pulmonary artery systolic pressure(PASP) were defined according to ASE guidelines(2010;23:685-713). Carotid intima-media thickness(IMT) and ankle-brachial blood pressure index(ABI) were measured using standard protocols. MS was defined according to AHA/NHLBI(2005;112:2735-52).
RESULTS: Patients had mean age 71 yrs(range 65-81), mean pack/years 50. Thirteen patients were GOLD I, 26 II, 21 III. Mean BODE index was 1.6(range 0-8), CCI 2.1(range 1-7) and mean±SD CAT 14±7. Eighty-three% patients had one or more chronic co-morbidities, the commonest were hypertension(65%), ischemic heart disease(18%), depression(18%), diabetes(10%), osteoporosis(8%). MS was found in 42%. The number of comorbidities was not associated with age and COPD severity. Mean LVEF was 64% (range 34-80), and CHF was diagnosed in one patient. Mean±SD TAPSE was 19±3 mm, PAPS 15±15 mmHg. Focal carotid plaque was identified in 58% patients: 8% had history of carotid atherosclerosis, 17% history of aortic aneurysm, stroke, myocardial infarction, 33% did not. Interestingly, a positive significant association (p=0.005) was found between CCI and the presence of plaque. Mean±SD left IMT was 1.7±0.8 mm, right 1.7±0.7. Mean±SD ABI was 0.99±0.1; value <0.9 was reported in 10% patients without history of peripheral arterial disease.
CONCLUSIONS: These results confirm a very high prevalence of chronic co-morbidities associated to COPD, and subclinical carotid atherosclerosis in up to 50% of elderly heavy smokers COPD patients. Interestingly, the presence of carotid plaque was associated with the number of comorbidities.
CLINICAL IMPLICATIONS: The high prevalence of subclinical atherosclerosis may explain the increased risk of cardiovascular morbidity and mortality in elderly COPD patients, who might then benefit of cardiovascular therapy. Funded by Ministero Salute and Chiesi Foundation.
DISCLOSURE: The following authors have nothing to disclose: Alessia Verduri, Mihai Roca, Monica Bortolotti, Martina Garofalo, Sara Balduzzi, Jessica Veronesi, Chiara Leuzzi, Enrico Clini, Leonardo Fabbri, Bianca Beghé
No Product/Research Disclosure InformationRespiratory Department, University of Modena and Reggio Emilia, Modena, Italy