Right Ventricle Function in Patients with Acute Coronary Syndrome and Concomitant Undiagnosed Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is frequently undiagnosed in patients with ischemic heart disease. Nowadays, it is still unknown whether undiagnosed concomitant COPD is related to early structural changes of the heart, as detectable by trans-thoracic echocardiography (TTE). Starting from the study population of the Screening for COPD in ACS Patients (SCAP) trial, we sought to investigate potential differences in echocardiographic parameters in patients with acute coronary syndromes (ACS), with or without undiagnosed concomitant COPD. Overall, 137 patients were included. Undiagnosed COPD was detected by spirometry in 39 (29%) patients. TTE was performed at inclusion (before hospital discharge) and after six months. Several echocardiographic parameters including fractional area change (FAC) and RV strain (RVS), were measured. Patients with undiagnosed COPD, as compared to those without COPD, showed lower FAC and reduced RVS both at inclusion (37 ± 6% vs. 44 ± 9%, p < 0.001; −15 ± −4 vs. −20 ± −5, p < 0.001, respectively) and after six months (38 ± 7% vs. 45 ± 9%, p < 0.001; −16 ± −4 vs. −20 ± −5, p < 0.001, respectively). After multivariate analysis undiagnosed COPD was independently associated with lower FAC and reduced RVS at baseline and at TTE after six months. Early impairment of RV function can be detected in ACS patients with concomitant undiagnosed COPD. If these alterations may be changed by an early diagnosis and an early treatment, should be evaluated in future studies. Clinical trial registration: NCT02324660.

Keywords:

• Strain
• fractional area change
• right ventricle
• undiagnosed COPD
• acute coronary syndrome

Ethics approval and consent to participate

All patients signed written informed consent. The study was approved by the Local Ethic Committee (Comitato Etico Unico della Provincia di Ferrara).

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declaration of interest

The authors declare that they have no competing interests.

Authors’ contributions

Rita Pavasini is the guarantor of the content of the manuscript, including the data and analysis. Rita Pavasini, Gianluca Campo, Andrea Fiorencis: conception, design, analysis and interpretation of data. Rita Pavasini, Gianluca Campo, Marco Contoli, Simone Biscaglia: data analysis and interpretation. All authors: drafting of the manuscript and revising it critically for important intellectual content. All authors: final approval of the manuscript submitted.