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

Figures & data

Table 1. Baseline characteristics of the study population.

	Undiagnosed COPD (according GOLD document)		Airflow limitation (according to ATS-ERS recommendation)
	No (n = 98)	Yes (n = 39)	No (n = 94)	Yes (n = 43)	P1	P2
Age, (years)	63 ± 11	69 ± 8	65 ± 9	68 ± 7	<0.01	0.03
Male sex, no. (%)	83 (85)	32 (82)	79 (81)	36 (83)	0.8	0.9
BMI, (Kg/m2)	28 ± 4	27 ± 4	28 ± 4	27 ± 4	0.2	0.3
Diabetes, no. (%)	21 (21)	11 (28)	20 (21)	12 (28)	0.5	0.4
Hypertension, no. (%)	67 (68)	25 (64)	64 (68)	28 (65)	0.7	0.7
Hyperlipidemia, no. (%)	55 (56)	17 (44)	52 (56)	20 (47)	0.2	0.3
Current smoker, no. (%)	44 (45)	17 (44)	42 (45)	19 (44)	0.9	0.9
Previous smoker, no. (%)	54 (55)	22 (56)	52 (55)	24 (55)	0.8	0.9
Pack/years	28 [15–45]	40 [16–60]	26 [13–43]	40 [16–60]	<0.01	<0.01
Prior MI, no. (%)	16 (16)	8 (21)	16 (17)	8 (18)	0.3	0.8
Prior PCI, no. (%)	18 (18)	6 (15)	18 (19)	6(14)	0.8	0.5
Prior CABG, no. (%)	5 (5)	2 (5)	6 (6)	1 (2)	0.9	0.3
Clinical presentation, no. (%)
STEMI	40 (41)	19 (49)	40 (43)	19 (44)	0.6	0.7
NSTEMI	34 (35)	14 (36)	31 (33)	17 (40)
Unstable angina	24 (24)	6 (15)	23 (24)	7 (16)
Angiographic data
Multivessel PCI	15 (15)	7 (18)	14 (15)	8 (19)	0.6	0.6
Target vessel of PCI
LAD	53 (54)	21 (54)	53 (56)	22 (52)	0.8	0.9
LCx	25 (25)	10 (25)	26 (28)	9 (21)
RCA	32 (32)	14 (35)	32 (30)	14 (32)
LM	3 (3)	1 (2)	3 (3)	1 (2)
Cardiovascular therapy, no. (%)
Aspirin	97 (99)	39 (100)	93 (99)	43 (100)	0.9	0.9
P2Y12 inhibitor	98 (100)	39 (100)	94 (100)	43 (100)	0.9	0.9
Beta-blocker	84 (86)	35 (90)	81 (86)	38 (89)	0.8	0.7
ACE inhibitor/ARB antagonist	88 (90)	37 (95)	86 (91)	39 (91)	0.5	0.9
Statin	96 (98)	37 (95)	92 (98)	41 (95)	0.3	0.4
RSHQ	18[15–21]	22[18–24]	17[14–20]	23[19–25]	<0.01	<0.01
Lung function data
VC (L)	3.9 ± 0.8	3.4 ± 0.7	3.9 ± 0.8	3.5 ± 0.7	<0.01	0.02
VC (% predicted)	102 ± 19	97 ± 22	102 ± 19	98 ± 21	0.2	0.3
FVC (L)	3.8 ± 0.8	3.3 ± 0.7	3.8 ± 0.9	3.3 ± 0.7	<0.01	<0.01
FVC (% predicted)	102 ± 19	97 ± 20	102 ± 19	97 ± 20	0.1	0.1
FEV1 (L)	2.9 ± 0.7	2.1 ± 0.5	2.8 ± 0.7	2.1 ± 0.5	<0.01	<0.01
FEV1 (% predicted)	98 ± 16	78 ± 15	98 ± 16	80 ± 15	<0.01	<0.01
Post-bronchodilator FEV1 (L)	2.8 ± 0.6	2.2 ± 0.5	2.8 ± 0.6	2.3 ± 0.5	<0.01	<0.01
Post-bronchodilator FEV1 (% predicted)	100 ± 19	83 ± 15	100 ± 18	82 ± 16	<0.01	<0.01
Post-bronchodilator FEV1/FVC (%)	76 ± 6	65 ± 5	75 ± 7	66 ± 7	<0.01	<0.01
FEV1/VC % predicted	86 ± 5	77 ± 7	90 ± 1.8	78 ± 7	<0.01	<0.01

COPD: chronic obstructive pulmonary disease. BMI: body mass index. MI: myocardial infarction. PCI: percutaneous coronary intervention. CABG: coronary artery bypass graft. STEMI: ST-segment elevation myocardial infarction. NSTEMI non ST-segment elevation myocardial infarction. UA: unstable angina. LAD: left anterior descending. LCx: left circumflex. RCA: right coronary artery. LM: left main. ACE: Angiotensin converting enzyme. ARB: angiotensin 2 receptor. RSHQ: Respiratory Health Status Questionnaire. PEF: Peak expiratory flow. P1: comparison between patients with or without COPD [1]; P2: comparison between patients with or without airflow limitation [8].

Table 2. Baseline and six-month trans-thoracic echocardiography (TTE) in patient with or without COPD [1].

	Baseline TTE parameters in patients with concomitant Undiagnosed COPD			6-month TTE parameters in patients with concomitant Undiagnosed COPD
Left heart	No (n = 98)	Yes (n = 39)	p	No (n = 95)	Yes (n = 38)	p	p1	p2
biEDV, ml	114 ± 37	114 ± 33	0.9	101 ± 22	114 ± 29	0.7	0.9	0.8
biESV, ml	54 ± 3	57 ± 5	0.6	54 ± 27	57 ± 26	0.9	0.9	0.5
EF, %	54 ± 12	51 ± 10	0.3	52 ± 8	56 ± 9	0.7	0.8	0.7
LV GLS	−13 ± −4	−13 ± −4	0.3	−15 ± −4	−15 ± −4	0.3	<0.001	0.005
LAVol i, ml/m^2	23 ± 10	27 ± 12	0.08	24 ± 13	27 ± 15	0.2	0.5	0.8
E wave, cm/s	75 ± 24	76 ± 26	0.9	67 ± 12	69 ± 15	0.1	0.1	0.9
A wave, cm/s	74 [58–83]	71 [60–83]	0.4	80 [35–130]	85 [52–105]	0.4	0.9	0.7
E/A	1 [0.8–1.4]	1.1 [0.7–1.5]	0.2	0.9 [0.5–2.2]	0.9 [0.5–1.7]	0.3	0.6	0.7
dT, ms	208 [168–247]	217 [174–282]	0.8	263 [179–325]	235 [160–334]	0.5	0.1	0.6
e’, cm/s	6 ± 2	5 ± 1	0.3	7 ± 2	7 ± 2	0.6	0.3	0.2
E/e’	12 [7–22]	15 [8–25]	0.3	9[7–17]	7[6–15]	0.1	0.2	0.2
Right heart
FAC, %	44 ± 9	37 ± 6	<0.001	45 ± 9	38 ± 7	<0.001	0.2	0.3
Basal dmt, cm	3.6 ± 0.6	3.6 ± 0.7	0.8	3.4 ± 0.7	3.7 ± 0.7	0.7	0.4	0.5
TAPSE, cm	2.0 ± 0.4	2.0 ± 0.4	0.8	2.2 ± 0.3	1.9 ± 0.7	0.2	0.2	0.4
RV thickness, cm	0.4 ± 0.1	0.5 ± 0.1	0.3	0.4 ± 0.1	0.5 ± 0.2	0.6	0.1	0.2
RA Vol i, ml/m^2	21 ± 9	23 ± 8	0.3	22 ± 10	27 ± 8	0.01	0.5	0.03
mPAP, mmHg	30 ± 9	26 ± 11	0.3	28 ± 11	25 ± 13	0.9	0.6	0.7
sPAP, mmHg	35 ± 11	36 ± 13	0.7	27 ± 12	35 ± 14	0.001	0.03	0.7
ACT, ms	110 ± 23	119 ± 25	0.3	118 ± 25	111 ± 30	0.7	0.6	0.7
RVS	−20 ± −5	−15 ± −4	<0.001	−20 ± −5	−16 ± −5	<0.001	0.6	0.3

p1: for the comparison between baseline vs. 6-month in patients without undiagnosed COPD.

p2: for the comparison between baseline vs. 6-month in patients with undiagnosed COPD.

TTE: trans-thoracic echocardiography. COPD: chronic obstructive pulmonary disease.

biEDV: biplane end-diastolic volume; biESV: biplane end-systolic volume; EF: ejection fraction; LV GLS: left ventricle global longitudinal strain; LAVol i: left atrium volume indexed for BSA; dt: deceleration time; FAC: fractional area change; Basal dmt: basal diameter; TAPSE: tricuspid annular plane systolic escursion; RV: right ventricle; RA Vol i: right atrium volume indexed for BSA; mPAP: mean pulmonary arterial pressure; sPAP: systolic pulmonary arterial pressure; ACT: acceleration time; RVS: strain of the free wall of the right ventricle.

Table 3. Baseline and six-month trans-thoracic echocardiography (TTE) in patients with or without airflow limitation [8].

	Baseline TTE parameters In patients with Airflow limitation			6-month TTE parameters In patients with Airflow limitation
Left heart	No (n = 94)	Yes (n = 43)	p	No (n = 91)	Yes (n = 42)	p	p1	p2
biEDV, ml	112 ± 37	115 ± 32	0.7	114 ± 37	113 ± 39	0.8	0.8	0.7
biESV, ml	54 ± 27	57 ± 26	0.6	54 ± 3	53 ± 28	0.9	0.5	0.9
EF, %	53 ± 11	52 ± 10	0.6	54 ± 12	54 ± 12	0.6	0.8	0.9
LV GLS	−13 ± −3	−12 ± −4	0.3	−13 ± −4	−15 ± −3	0.3	0.002	0.001
LAVol i, ml/m^2	23 ± 10	27 ± 11	0.1	23 ± 10	29 ± 10	0.3	0.1	0.06
E wave, cm/s	74 ± 24	77 ± 23	0.5	75 ± 24	75 ± 21	0.1	0.2	0.9
A wave, cm/s	79 [59–90]	78 [59–90]	0.5	77 [55–86]	74 [60–85]	0.9	0.9	0.8
E/A	0.6 [0.8–1.2]	0.9 [0.7–1.1]	0.2	1 [0.8–1.4]	0.8 [0.7–1.2]	0.5	0.5	0.8
dT, ms	219 [172–280]	207 [160–263]	0.5	206 [164–232]	251 [192–300]	0.07	0.4	0.6
é, cm/s	6 ± 2	5 ± 9	0.2	6 ± 2	8 ± 2	0.6	0.3	0.2
E/é	9 [7–17]	7 [6–15]	0.4	12 [7–22]	1 [7–22]	0.3	0.2	0.3
Right heart
FAC, %	43 ± 13	36 ± 6	0.007	45 ± 9	41 ± 8	0.03	0.21	0.3
Basal dmt, cm	3.4 ± 0.7	3.7 ± 0.7	0.8	3.4 ± 0.6	3.6 ± 0.6	0.2	0.4	0.5
TAPSE, cm	2.0 ± 0.4	2.1 ± 0.4	0.6	2.1 ± 0.4	2.1 ± 0.4	0.9	0.3	0.9
RV thickness, cm	0.4 ± 0.1	0.5 ± 0.2	0.8	0.4 ± 0.2	0.4 ± 0.1	0.9	0.1	0.3
RA Vol i, ml/m^2	20 ± 9	21 ± 9	0.6	24 ± 9	26 ± 9	0.1	0.5	0.004
mPAP, mmHg	29 ± 10	25 ± 11	0.3	27 ± 10	28 ± 11	0.7	0.4	0.3
sPAP, mmHg	34 ± 10	38 ± 12	0.04	26 ± 16	29 ± 15	0.4	0.05	0.1
ACT, ms	110 ± 22	120 ± 24	0.3	115 ± 23	116 ± 26	0.8	0.4	0.4
RVS	−19 ± −5	−16 ± −3	0.01	−20 ± −5	−15 ± −4	0.006	0.4	0.1

p1: for the comparison between baseline vs. 6-month in patients without undiagnosed COPD.

p2: for the comparison between baseline vs. 6-month in patients with undiagnosed COPD.

TTE: trans-thoracic echocardiography. COPD: chronic obstructive pulmonary disease.

biEDV: biplane end-diastolic volume; biESV: biplane end-systolic volume; EF: ejection fraction; LV GLS: left ventricle global longitudinal strain; LAVol i: left atrium volume indexed for BSA; dt: deceleration time; FAC: fractional area change; Basal dmt: basal diameter; TAPSE: tricuspid annular plane systolic escursion; RV: right ventricle; RA Vol i: right atrium volume indexed for BSA; mPAP: mean pulmonary arterial pressure; sPAP: systolic pulmonary arterial pressure; ACT: acceleration time; RVS: strain of the free wall of the right ventricle.

Table 4. Bland-Altman scatterplot analysis, and calculated intraclass correlation coefficients (ICCs).

	FAC baseline	FAC follow-up	RVS baseline	RVS follow-up
Bland-Altman scatterplot values
Mean difference	0.91	0.89	0.3	0.3
Agreement limits (lower, higher)	−4.1 to 6.2	−4 to 5.9	−1.7 to 2.4	−1.5 to 2.2
ICC
ICC	0.84	0.85	0.92	0.94
95% CI	0.70–0.94	0.72–0.96	0.82–0.97	0.85–0.98
p	<0.001	<0.001	<0.001	<0.001

ICC: intraclass correlation coefficients; CI: confidence interval.

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Availability of data and material

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