ERS Respiratory Channel

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Abstract

BACKGROUND: High intrathoracic pressure in chronic obstructive pulmonary disease (COPD) is related to impaired cardiac function.

AIMS AND OBJECTIVES: To evaluate the relation between findings in plethysmography and cardiac ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) imaging in patients with newly diagnosed moderate-to-severe COPD without left-sided heart failure.

METHODS: We studied 15 patients with newly diagnosed moderate-to-severe COPD of 41-76 years old. Plethysmography, cardiac magnetic resonance imaging and cardiac ¹²³I-MIBG imaging were performed before the treatment with bronchodilators.

RESULTS: All patients had a normal left ventricle (LV) ejection fraction (EF) (median LVEF 58%; IQR 8.5), but impaired cardiac adrenergic innervation (median washout rate 39%; IQR 18). A negative correlation between late heart to mediastinum ratio (HMR) and specific airway resistance (r=-0.524; p=0.045) as well as a positive correlation between late HMR and specific airway conduction (r=0.524; p=0.045) was observed. Air trapping was dominant (n=10) compared to hyperinflation (n=3). Residual volume to total lung capacity ratio negatively correlated with LV late total defect score (r= -0.628; p=0.016).

CONCLUSIONS: Despite normal LV function and no expression of heart failure, patients with newly diagnosed moderate-to-severe COPD may have impaired cardiac adrenergic innervation. Moreover, there is a link between air trapping and LV regional adrenergic innervation which may lead to a higher cardiovascular risk. 123I-MIBG imaging may be useful in estimating the probability of arrhythmic events and sudden cardiac death in patients with COPD.

Abstract

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