Cardiac imaging characteristics of patients with COPD: prognostic implications

Although COPD was originally thought to merely affect the airways and lungs, the attention of research has been shifted towards the high prevalence of cardiovascular disease in patients with COPD. Up to one third of deaths in patients with COPD can be attributed to a cardiovascular cause. In particular, a strong association between COPD and acute myocardial infarction (AMI) has been emphasized and the need for adequate risk stratification in this population has been recognized. Identification of patients at risk of adverse events after AMI is frequently performed with cardiac imaging. Echocardiography permits early assessment of left- and right ventricular size and function, as surrogates of cardiac damage in the acute phase. Emerging advanced echocardiographic techniques such as speckle tracking strain imaging enable characterization of myocardial mechanics, which have been associated with prognosis. Assessment of left- and right ventricular longitudinal strain in patient with COPD might provide better risk stratification as compared to conventional echocardiographic parameters. COPD is also a known risk factor for atrial fibrillation. Structural atrial remodeling, particularly of the right atrium, is suggested to be an important pathophysiologic substrate. Echocardiography may provide an additional tool in characterization of atrial structure and function, leading to targeted treatments.Boehringer Ingelheim; Hartonderzoek Nederland; Nederlandse hartstichtingLUMC / Geneeskund

Comparison of Left Ventricular Function and Myocardial Infarct Size Determined by 2-Dimensional Speckle Tracking Echocardiography in Patients With and Without Chronic Obstructive Pulmonary Disease After ST-Segment Elevation Myocardial Infarction

Cardiolog

Prevalence of aortic valve stenosis in patients with ST-segment elevation myocardial infarction and effect on long-term outcome

Several studies have shown an association between aortic valve stenosis (AS), atherosclerosis and cardiovascular risk factors. These risk factors are frequently encountered in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the prevalence and the prognostic implications of AS in patients presenting with STEMI. A total of 2041 patients (61 +/- 12 years old, 76% male) admitted with STEMI and treated with primary percutaneous coronary intervention were included. Patients with previous myocardial infarction and previous aortic valve replacement were excluded. Echocardiography was performed at index admission. Patients were divided in 3 groups: 1) any grade of AS, 2) aortic valve sclerosis and 3) normal aortic valve. Any grade of AS was defined as an aortic valve area = 85 years, respectively). Patients with AS showed a significantly higher mortality rate when compared to the other two groups (p < 0.001) and AS was independently associated with all-cause mortality, with a HR of 1.81 (CI 95%: 1.02 to 3.22; p = 0.04). In conclusion, AS is not uncommon in patients with STEMI, and concomitant AS in patients with first STEMI is independently associated with all-cause mortality at long-term follow up. (C) 2021 The Author(s). Published by Elsevier Inc.Cardiolog

Influence of chronic obstructive pulmonary disease on atrial mechanics by speckle tracking echocardiography in patients with atrial fibrillation

The present study aimed to examine differences in left- and right atrial characteristics between atrial fibrillation (AF) patients with and without chronic obstructive pulmonary disease (COPD). For this, 420 patients (mean age 68 +/- 10 years, 73% female) with first diagnosis of AF and baseline echocardiography were included. Of these, 143 COPD patients were compared with 277 patients without COPD matched by age, gender and body surface area. Additionally 38 healthy controls without cardiovascular risk factors, matched for age, were included. For all 3 groups, left atrial (LA) volumes and diameter, LA reservoir strain (LASr), left ventricular ejection fraction (LVEF), right atrial (RA) area and diameter, RA reservoir strain (RASr) and tricuspid annular plane systolic excursion were evaluated on transthoracic echocardiography. Baseline characteristics were similar in patients with and without COPD except for smoking and a history of heart failure (42% vs 11%, p < 0.001 and 48% vs 37%, p = 0.036 for COPD and non-COPD patients, respectively). Also, COPD patients less often used beta-blockers (63% vs 75%, p = 0.017). There were no significant differences in LVEF, LA volume and RA area between COPD and non-COPD patients. Compared to the controls, AF patients had impaired LVEF, LASr and RASr. Only RASr was significantly worse in COPD patients as compared to non-COPD patients (15.3% [9.0 to 25.1] vs 19.6% [11.8 to 28.5], p = 0.013). Additionally, a trend towards worse RASr was observed with increasing COPD severity. In conclusion, AF patients with concomitant COPD have more impaired RA function compared to patients without COPD but with similar atrial size and LA function. (C) 2020 The Author(s). Published by Elsevier Inc.Cardiolog

Prognostic value of multilayer left ventricular global longitudinal strain in patients with ST-segment elevation myocardial infarction with mildly reduced left ventricular ejection fractions

Multilayer (epi-, mid- and endocardium) left ventricular (LV) global longitudinal strain (GLS) reflects the extent of myocardial damage after ST-segment myocardial infarction (STEMI). However, the prognostic implications of multilayer LV GLS remain unclear. We studied the association between multilayer LV GLS and prognosis in patients with mildly reduced or preserved LV ejection fraction (EF) after STEMI. Patients with first STEMI and LVEF>45% were evaluated retrospectively. Baseline multilayer (endocardial, mid-myocardial and epicardial) LV GLS were measured on 2-dimensional speckle tracking echocardiography. Patients were followed up for of all-cause mortality. A total of 569 patients (77% male, 60 +/- 11 years) were included. After a median follow-up of 117 (interquartile range 106-132) months, 95 (17%) patients died. We observed no differences in baseline LVEF and peak troponin levels between survivors and non-survivors. However, non-survivors showed more impaired GLS at all layers (epicardium: -11.9 +/- 2.8% vs. -13.4 +/- 2.8%; mid-myocardium: -14.2 +/- 3.2% vs. -15.6 +/- 3.2%; endocardium: -16.5 +/- 3.7% vs. -17.7 +/- 3.6%, p<0.05, for all). On multivariable analysis, increasing age (hazard ratio 1.095; p<0.001) and impaired LV GLS of the epicardial layer (hazard ratio 1.085; p = 0.047) were independently associated with higher risk of all-cause mortality. In addition, LV GLS at the epicardium had incremental prognostic value for all-cause mortality (chi(2) = 114, p = 0.044). In conclusion, in contemporary STEMI patients with mildly reduced or preserved LVEF, ageing and reduced LV GLS of the epicardium (reflecting transmural scar formation) were independently associated with all-cause mortality after adjusting for clinical and echocardiographic variables. (C) 2021 The Authors. Published by Elsevier Inc.Cardiolog

Tumor-derived GDF-15 blocks LFA-1 dependent T cell recruitment and suppresses responses to anti-PD-1 treatment

Immune checkpoint blockade therapy is beneficial and even curative for some cancer patients. However, the majority don’t respond to immune therapy. Across different tumor types, pre-existing T cell infiltrates predict response to checkpoint-based immunotherapy. Based on in vitro pharmacological studies, mouse models and analyses of human melanoma patients, we show that the cytokine GDF-15 impairs LFA-1/β2-integrin-mediated adhesion of T cells to activated endothelial cells, which is a pre-requisite of T cell extravasation. In melanoma patients, GDF-15 serum levels strongly correlate with failure of PD-1-based immune checkpoint blockade therapy. Neutralization of GDF-15 improves both T cell trafficking and therapy efficiency in murine tumor models. Thus GDF-15, beside its known role in cancer-related anorexia and cachexia, emerges as a regulator of T cell extravasation into the tumor microenvironment, which provides an even stronger rationale for therapeutic anti-GDF-15 antibody development. Experimental cancer immunology and therap

Cardiac imaging characteristics of patients with COPD: prognostic implications

Although COPD was originally thought to merely affect the airways and lungs, the attention of research has been shifted towards the high prevalence of cardiovascular disease in patients with COPD. Up to one third of deaths in patients with COPD can be attributed to a cardiovascular cause. In particular, a strong association between COPD and acute myocardial infarction (AMI) has been emphasized and the need for adequate risk stratification in this population has been recognized. Identification of patients at risk of adverse events after AMI is frequently performed with cardiac imaging. Echocardiography permits early assessment of left- and right ventricular size and function, as surrogates of cardiac damage in the acute phase. Emerging advanced echocardiographic techniques such as speckle tracking strain imaging enable characterization of myocardial mechanics, which have been associated with prognosis. Assessment of left- and right ventricular longitudinal strain in patient with COPD might provide better risk stratification as compared to conventional echocardiographic parameters. COPD is also a known risk factor for atrial fibrillation. Structural atrial remodeling, particularly of the right atrium, is suggested to be an important pathophysiologic substrate. Echocardiography may provide an additional tool in characterization of atrial structure and function, leading to targeted treatments.</table

Cardiac imaging characteristics of patients with COPD: prognostic implications

Although COPD was originally thought to merely affect the airways and lungs, the attention of research has been shifted towards the high prevalence of cardiovascular disease in patients with COPD. Up to one third of deaths in patients with COPD can be attributed to a cardiovascular cause. In particular, a strong association between COPD and acute myocardial infarction (AMI) has been emphasized and the need for adequate risk stratification in this population has been recognized. Identification of patients at risk of adverse events after AMI is frequently performed with cardiac imaging. Echocardiography permits early assessment of left- and right ventricular size and function, as surrogates of cardiac damage in the acute phase. Emerging advanced echocardiographic techniques such as speckle tracking strain imaging enable characterization of myocardial mechanics, which have been associated with prognosis. Assessment of left- and right ventricular longitudinal strain in patient with COPD might provide better risk stratification as compared to conventional echocardiographic parameters. COPD is also a known risk factor for atrial fibrillation. Structural atrial remodeling, particularly of the right atrium, is suggested to be an important pathophysiologic substrate. Echocardiography may provide an additional tool in characterization of atrial structure and function, leading to targeted treatments.</table

COPD and acute myocardial infarction

COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and AMI. The prevalence of COPD amongst AMI populations ranges from 7% to 30%, which is possibly even an underestimation due to underdiagnoses of COPD in general. Following the acute event, patients with COPD have an increased risk of mortality, heart failure and arrhythmias during follow-up. Adequate risk stratification can be performed using various imaging techniques, evaluating cardiac size and function after AMI. Conventional imaging techniques such as echocardiography and cardiac magnetic resonance imaging have already indicated impaired cardiac function in patients with COPD without known cardiovascular disease. Advanced imaging techniques such as speckle-tracking echocardiography and T1 mapping could provide more insight into cardiac structure and function after AMI and have proven to be of prognostic value. Future research is required to better understand the impact of AMI on patients with COPD in order to provide effective secondary prevention. The present article summarises the current knowledge on the pathophysiologic factors involved in the interaction between COPD and AMI, the prevalence and outcomes of AMI in patients with COPD and the role of imaging in the acute phase and risk stratification after AMI in patients with COPD.Cardiolog