title: Co-existence of COPD and left ventricular dysfunction in vascular surgery patients.
abstract: BACKGROUND
  The co-existence between chronic obstructive pulmonary disease (COPD) and heart failure has been previously described. However, the co-existence between COPD and subclinical left ventricular (LV) dysfunction, without the presence of heart failure symptoms, is less well understood. This study determined the relationship and clinical relevance of COPD and subclinical LV dysfunction in vascular surgery patients.
  
  
  METHODS
  1005 consecutive vascular surgery patients were included in which COPD was determined using spirometry and LV function using echocardiography. Mild COPD was defined as FEV(1)>or=80% of predicted+FEV(1)/FVC-ratio<0.70. Moderate/severe COPD was defined as FEV(1)<80% of predicted+FEV(1)/FVC-ratio<0.70. Systolic LV dysfunction was defined as LV ejection fraction <50% and diastolic LV dysfunction was diagnosed based on E/A-ratio, pulmonary vein flow and deceleration time. Multivariate regression analyses were used to evaluate the impact of COPD and LV dysfunction on all-cause mortality. The mean follow-up time was 2.2+/-1.8 years.
  
  
  RESULTS
  Both, mild and moderate/severe COPD were associated with increased risk for subclinical LV dysfunction with odds ratio of 1.6 (95%-CI=1.1-2.3) and 1.7 (95%-CI=1.2-2.4), respectively. Mild- or moderate/severe COPD in combination with LV dysfunction was associated with increased risk for all-cause mortality (mild: hazard ratio 1.7; 95%-CI=1.1-3.6, moderate/severe: hazard ratio 2.5; 95%-CI=1.5-4.7).
  
  
  CONCLUSIONS
  COPD was associated with increased risk for subclinical LV dysfunction. COPD+subclinical LV dysfunction was associated with increased risk for all-cause mortality compared to patients with COPD+normal LV function. Echocardiography may be useful to detect subclinical cardiovascular disease and risk-stratify COPD patients undergoing vascular surgery.
authors.affiliation: Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Flu
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: van Kuijk
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Ruud
authors.initials: R
authors.lastname: Kuiper
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D000873:Anthracenes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D014656:Vascular Surgical Procedures; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology
chemical_list: C546739:AnOV compound; D000873:Anthracenes