Heart Problems in COPD Patients Increase Mortality Risk – Important Distinctions for Targeted Treatments

DZL-scientists identify two main types of heart impairment in COPD patients, which differently affect the risk of mortality. Therefore, precise diagnosis is crucial for developing targeted treatment approaches.

A new study conducted by a research team from all five sites of the German Center for Lung Research (DZL) provides significant insights into the heart health of patients with chronic obstructive pulmonary disease (COPD). Under the leadership of DZL scientist PD Dr. med. Benjamin Waschki and lead author Dr. med. Mustafa Abdo at the Airway Research Center North (ARCN) of the LungenClinic Grosshansdorf, it was shown that heart problems in COPD patients are associated with an increased risk of mortality. It is particularly important to distinguish between two main causes of these heart problems: heart failure with preserved ejection fraction (HFpEF) and reduced blood return to the heart, indicated by a smaller left heart chamber size.

In the comprehensive study, which examined COPD patients from the COSYCONET cohort, an echocardiogram (TTE) was performed to determine whether they have a small left ventricle (LV) or features of heart failure with preserved ejection fraction (HFpEF). HFpEF is a heart disease where the heart ejects blood normally but has difficulty filling adequately, leading to symptoms like shortness of breath and fatigue. Similarly, with a small left ventricle, the heart cannot fill with enough blood, leading to reduced cardiac output and heart failure. The main focus of the study was on mortality after four and a half years.

Of over 1,700 COPD patients, eight percent had a small LV, 16 percent had HFpEF features, and 45 percent had normal echocardiogram findings. Patients with a small LV or HFpEF features had higher mortality rates than those with normal ultrasound findings. The risk of death was about 2.75 times higher in patients with a small LV and about 2.16 times higher in those with HFpEF features. The distinction between these two heart problems is crucial because they have different causes and treatment options.

Comprehensive Diagnosis for Identifying High-Risk Patients and Tailored Therapies

The study used comprehensive diagnostic methods, such as ultrasound and the measurement of heart and lung markers, to determine which patients are at higher risk of early mortality. These findings highlight the need to precisely diagnose and treat heart problems in COPD patients. While HFpEF is often treated with medications that regulate blood pressure and heart load, patients with a small left ventricle could benefit from therapies that reduce lung hyperinflation. Lung hyperinflation occurs when the lungs expand beyond their normal size because air is trapped inside, causing symptoms like difficulty inhaling and shortness of breath. Treatment includes specialized medications, breathing exercises, or oxygen therapy.

By targeted management of the different heart problems, the life expectancy of these patients could be improved, and the impact of heart problems on their health could be significantly reduced.

Original publication:

Abdo M, Watz H, Alter P, Kahnert K, Trudzinski F, Groth EE, Claussen M, Kirsten AM, Welte T, Jörres RA, Vogelmeier CF, Bals R, Rabe KF, Waschki B. Characterization and Mortality Risk of Impaired Left Ventricular Filling in COPD. Am J Respir Crit Care Med. 2024 Jul 10. doi: 10.1164/rccm.202310-1848OC. Epub ahead of print. PMID: 38984876.