title: Echocardiographic abnormalities and their impact on health status in patients with COPD referred for pulmonary rehabilitation.
abstract: Both patients with cardiac diseases as well as those with COPD report an impaired health status. The frequencies of objectively assessed co-morbid cardiac diseases and their impact on health status in patients with COPD are unknown. We aimed to investigate echocardiographic abnormalities and their impact on health status in a large cohort of patients with COPD referred for pulmonary rehabilitation (PR).
  
  
  
  In this cross-sectional, observational analyses, demographic and clinical characteristics were assessed during an inpatient pre-PR assessment. All patients underwent Doppler echocardiographic evaluation. Health status was assessed using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and St George's Respiratory Questionnaire (SGRQ).
  
  
  
  A total of 514 patients (55.3% males, age: 64.1 (9.1) years, forced expiratory volume in 1 s (FEV1): 48.6 (20.0) % predicted) were included for analyses. Two hundred and seventy-six patients (53.7%) were diagnosed with one or more echocardiographic abnormalities. Most prevalent were left ventricular (LV) hypertrophy (LVH, 31.0%), increased right ventricular systolic pressure (RVSP, 20.4%) and impaired LV ejection fraction (LVEF, 16.5%). Of the 276 patients, 176 (63.8%) with echocardiographic abnormalities did not have these recorded in their medical history. Patients with echocardiographic abnormalities reported a worse health status as assessed with the SGRQ total score (62.5 (17.1) vs 59.3 (17.6) points, P = 0.044). CCQ and CAT did not differ between groups.
  
  
  
  More than half of the patients referred to PR had echocardiographic abnormalities of which two-third did not have them recorded in their medical history. We detected a limited impact of echocardiographic abnormalities on health status.
authors.affiliation: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Houben-Wilke
authors.affiliation: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.affiliation: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.|Department of Cardiology, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.
authors.forename: Nicole H M K
authors.initials: NHMK
authors.lastname: Uszko-Lencer
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.
authors.forename: Gosia
authors.initials: G
authors.lastname: Otkinska
authors.affiliation: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.|Department of Respiratory Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.
authors.forename: Lowie E G W
authors.initials: LEGW
authors.lastname: Vanfleteren
authors.affiliation: Division of Clinical Science, St. George's University of London, London, UK.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.|Department of Respiratory Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.
authors.forename: Emiel F M
authors.initials: EFM
authors.lastname: Wouters
authors.affiliation: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.|Department of Respiratory Medicine, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands.
authors.forename: Frits M E
authors.initials: FME
authors.lastname: Franssen
mesh_terms: D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D012129:Respiratory Function Tests; D012138:Respiratory Therapy; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000453:epidemiology; D014797:Vital Capacity
keywords: Chronic Obstructive Pulmonary Disease Assessment Test; Clinical Chronic Obstructive Pulmonary Disease Questionnaire; St George's Respiratory Questionnaire; co-morbidity; echocardiography