title: Influence of Left Ventricular Hypertrophy on In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.
abstract: Left ventricular hypertrophy (LVH) is associated with worse outcomes in chronic obstructive pulmonary disease (COPD); however, its role in an acute exacerbation of COPD (AECOPD) has not been reported. This was a retrospective cohort study during 2008-2012 at an academic medical center. AECOPD patients >18 years with available echocardiographic data were included. LVH was defined as LV mass index (LVMI) >95 g/m2(women) and >115g/m2(men). Relative wall thickness was used to classify LVH as concentric (>0.42) or eccentric (<0.42). Outcomes included need for and duration of non-invasive ventilation (NIV) and mechanical ventilation (MV), NIV failure, intensive care unit (ICU) and total length of stay (LOS), and in-hospital mortality. Two-tailed p < 0.05 was considered statistically significant. Of 802 patients with AECOPD, 615 patients with 264 (42.9%) having LVH were included. The LVH cohort had higher LVMI (141.1 ± 39.4 g/m2vs. 79.7 ± 19.1 g/m2; p < 0.001) and lower LV ejection fraction (44.5±21.9% vs. 50.0±21.6%; p ≤ 0.001). The LVH cohort had statistically non-significant longer ICU LOS, and higher NIV and MV use and duration. Of the 264 LVH patients, concentric LVH (198; 75.0%) was predictive of greater NIV use [82 (41.4%) vs. 16 (24.2%), p = 0.01] and duration (1.0 ± 1.9 vs. 0.6 ± 1.4 days, p = 0.01) compared to eccentric LVH. Concentric LVH remained independently associated with NIV use and duration. In-hospital outcomes in patients with AECOPD were comparable in patients with and without LVH. Patients with concentric LVH had higher NIV need and duration in comparison to eccentric LVH.
authors.affiliation: a Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic , Rochester , MN , USA.|b Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic , Rochester , MN , USA.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.affiliation: c Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic , Rochester , MN , USA.
authors.forename: Pranathi R
authors.initials: PR
authors.lastname: Sundaragiri
authors.affiliation: d Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Kanmanthareddy
authors.affiliation: e Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Tufts University School of Medicine , Boston , MA , USA.
authors.forename: Anas A
authors.initials: AA
authors.lastname: Ahmed
authors.affiliation: d Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Toufik
authors.initials: T
authors.lastname: Mahfood Haddad
authors.affiliation: f Department of Internal Medicine , Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Hamza A A
authors.initials: HA
authors.lastname: Rayes
authors.affiliation: g Department of Internal Medicine , Rush Medical College of Rush University , Chicago , IL , USA.
authors.forename: Anila N
authors.initials: AN
authors.lastname: Khan
authors.affiliation: f Department of Internal Medicine , Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Haitam M
authors.initials: HM
authors.lastname: Buaisha
authors.affiliation: f Department of Internal Medicine , Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Gene E
authors.initials: GE
authors.lastname: Pershwitz
authors.affiliation: h Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Dustin A
authors.initials: DA
authors.lastname: McCann
authors.affiliation: d Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Holmberg
authors.affiliation: h Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA.|i Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha , NE , USA.
authors.forename: Lee E
authors.initials: LE
authors.lastname: Morrow
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors
keywords: Acute exacerbation of chronic obstructive pulmonary disease; concentric hypertrophy; left ventricular hypertrophy; left ventricular mass index; non-invasive ventilation