Chronic obstructive pulmonary disease as a risk factor for ventricular arrhythmias independent of left ventricular function

Tomas Konecny, Kiran R. Somers, Jae Yoon Park, Alan John, Marek Orban, Rahul Doshi, Paul D Scanlon, Samuel J Asirvatham, Charanjit S. Rihal, Peter A. Brady

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: The association between chronic obstructive pulmonary disease (COPD) and sudden cardiac death has not been fully elucidated. Objective: The purpose of this study was to investigate whether decreased left ventricular ejection fraction (LVEF) can explain the increased rate of ventricular tachycardia (VT) in COPD. Methods: This retrospective study included consecutive adult patients who underwent pulmonary function testing (PFT), Holter monitoring, and transthoracic echocardiography. COPD was correlated with the frequency of VT in a multivariate analysis that adjusted for known confounders including LVEF. Long-term all-cause mortality of patients with COPD and VT was examined. Results: Of the 6351 patients included in this study (age 66 ± 15 years; 48% woman; 92% Caucasian, LVEF 59% ± 12%), 2800 (44%) had PFT indicative of COPD. VT was nearly twice as likely to occur during Holter monitoring in COPD patients (13% vs 23%; P <.001), and the severity of COPD correlated with the risk of VT (21% vs 28% vs 37% for mild–moderate, severe, and very severe COPD; P <.001). COPD and VT remained independently associated (P <.001) even after adjusting for LVEF, demographics, and comorbidities (age, sex, body mass index, hypertension, chronic kidney disease, coronary artery disease, cancer history, diabetes mellitus). COPD was associated with all-cause mortality independently of LVEF (P <.001). Conclusion: COPD patients are at higher risk for VT and mortality. This may not be fully attributed to the confounding effect of systolic heart failure measured by LVEF. Further studies are needed to explore the mechanistic interactions between VT and COPD in order to determine whether antiarrhythmic strategies would apply especially to patients with severe COPD.

Original languageEnglish (US)
Pages (from-to)832-838
Number of pages7
JournalHeart Rhythm
Volume15
Issue number6
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Fingerprint

Left Ventricular Function
Chronic Obstructive Pulmonary Disease
Cardiac Arrhythmias
Ventricular Tachycardia
Stroke Volume
Ambulatory Electrocardiography
Mortality
Systolic Heart Failure
Lung
Sudden Cardiac Death
Chronic Renal Insufficiency
Echocardiography
Comorbidity
Coronary Artery Disease
Diabetes Mellitus
Body Mass Index
Multivariate Analysis
Retrospective Studies
Demography
Hypertension

Keywords

  • Chronic obstructive pulmonary disease
  • Emphysema
  • Holter monitoring
  • Pulmonary function test
  • Sudden cardiac death
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Chronic obstructive pulmonary disease as a risk factor for ventricular arrhythmias independent of left ventricular function. / Konecny, Tomas; Somers, Kiran R.; Park, Jae Yoon; John, Alan; Orban, Marek; Doshi, Rahul; Scanlon, Paul D; Asirvatham, Samuel J; Rihal, Charanjit S.; Brady, Peter A.

In: Heart Rhythm, Vol. 15, No. 6, 01.06.2018, p. 832-838.

Research output: Contribution to journalArticle

Konecny, Tomas ; Somers, Kiran R. ; Park, Jae Yoon ; John, Alan ; Orban, Marek ; Doshi, Rahul ; Scanlon, Paul D ; Asirvatham, Samuel J ; Rihal, Charanjit S. ; Brady, Peter A. / Chronic obstructive pulmonary disease as a risk factor for ventricular arrhythmias independent of left ventricular function. In: Heart Rhythm. 2018 ; Vol. 15, No. 6. pp. 832-838.
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abstract = "Background: The association between chronic obstructive pulmonary disease (COPD) and sudden cardiac death has not been fully elucidated. Objective: The purpose of this study was to investigate whether decreased left ventricular ejection fraction (LVEF) can explain the increased rate of ventricular tachycardia (VT) in COPD. Methods: This retrospective study included consecutive adult patients who underwent pulmonary function testing (PFT), Holter monitoring, and transthoracic echocardiography. COPD was correlated with the frequency of VT in a multivariate analysis that adjusted for known confounders including LVEF. Long-term all-cause mortality of patients with COPD and VT was examined. Results: Of the 6351 patients included in this study (age 66 ± 15 years; 48{\%} woman; 92{\%} Caucasian, LVEF 59{\%} ± 12{\%}), 2800 (44{\%}) had PFT indicative of COPD. VT was nearly twice as likely to occur during Holter monitoring in COPD patients (13{\%} vs 23{\%}; P <.001), and the severity of COPD correlated with the risk of VT (21{\%} vs 28{\%} vs 37{\%} for mild–moderate, severe, and very severe COPD; P <.001). COPD and VT remained independently associated (P <.001) even after adjusting for LVEF, demographics, and comorbidities (age, sex, body mass index, hypertension, chronic kidney disease, coronary artery disease, cancer history, diabetes mellitus). COPD was associated with all-cause mortality independently of LVEF (P <.001). Conclusion: COPD patients are at higher risk for VT and mortality. This may not be fully attributed to the confounding effect of systolic heart failure measured by LVEF. Further studies are needed to explore the mechanistic interactions between VT and COPD in order to determine whether antiarrhythmic strategies would apply especially to patients with severe COPD.",
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AU - Somers, Kiran R.

AU - Park, Jae Yoon

AU - John, Alan

AU - Orban, Marek

AU - Doshi, Rahul

AU - Scanlon, Paul D

AU - Asirvatham, Samuel J

AU - Rihal, Charanjit S.

AU - Brady, Peter A.

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N2 - Background: The association between chronic obstructive pulmonary disease (COPD) and sudden cardiac death has not been fully elucidated. Objective: The purpose of this study was to investigate whether decreased left ventricular ejection fraction (LVEF) can explain the increased rate of ventricular tachycardia (VT) in COPD. Methods: This retrospective study included consecutive adult patients who underwent pulmonary function testing (PFT), Holter monitoring, and transthoracic echocardiography. COPD was correlated with the frequency of VT in a multivariate analysis that adjusted for known confounders including LVEF. Long-term all-cause mortality of patients with COPD and VT was examined. Results: Of the 6351 patients included in this study (age 66 ± 15 years; 48% woman; 92% Caucasian, LVEF 59% ± 12%), 2800 (44%) had PFT indicative of COPD. VT was nearly twice as likely to occur during Holter monitoring in COPD patients (13% vs 23%; P <.001), and the severity of COPD correlated with the risk of VT (21% vs 28% vs 37% for mild–moderate, severe, and very severe COPD; P <.001). COPD and VT remained independently associated (P <.001) even after adjusting for LVEF, demographics, and comorbidities (age, sex, body mass index, hypertension, chronic kidney disease, coronary artery disease, cancer history, diabetes mellitus). COPD was associated with all-cause mortality independently of LVEF (P <.001). Conclusion: COPD patients are at higher risk for VT and mortality. This may not be fully attributed to the confounding effect of systolic heart failure measured by LVEF. Further studies are needed to explore the mechanistic interactions between VT and COPD in order to determine whether antiarrhythmic strategies would apply especially to patients with severe COPD.

AB - Background: The association between chronic obstructive pulmonary disease (COPD) and sudden cardiac death has not been fully elucidated. Objective: The purpose of this study was to investigate whether decreased left ventricular ejection fraction (LVEF) can explain the increased rate of ventricular tachycardia (VT) in COPD. Methods: This retrospective study included consecutive adult patients who underwent pulmonary function testing (PFT), Holter monitoring, and transthoracic echocardiography. COPD was correlated with the frequency of VT in a multivariate analysis that adjusted for known confounders including LVEF. Long-term all-cause mortality of patients with COPD and VT was examined. Results: Of the 6351 patients included in this study (age 66 ± 15 years; 48% woman; 92% Caucasian, LVEF 59% ± 12%), 2800 (44%) had PFT indicative of COPD. VT was nearly twice as likely to occur during Holter monitoring in COPD patients (13% vs 23%; P <.001), and the severity of COPD correlated with the risk of VT (21% vs 28% vs 37% for mild–moderate, severe, and very severe COPD; P <.001). COPD and VT remained independently associated (P <.001) even after adjusting for LVEF, demographics, and comorbidities (age, sex, body mass index, hypertension, chronic kidney disease, coronary artery disease, cancer history, diabetes mellitus). COPD was associated with all-cause mortality independently of LVEF (P <.001). Conclusion: COPD patients are at higher risk for VT and mortality. This may not be fully attributed to the confounding effect of systolic heart failure measured by LVEF. Further studies are needed to explore the mechanistic interactions between VT and COPD in order to determine whether antiarrhythmic strategies would apply especially to patients with severe COPD.

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KW - Emphysema

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KW - Pulmonary function test

KW - Sudden cardiac death

KW - Ventricular tachycardia

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