title: Premature Ventricular Complex is More Prevalent During Acute Exacerbated than Stable States of Chronic Obstructive Pulmonary Disease, and Is Related to Cardiac Troponin T.
abstract: During acute exacerbation of chronic obstructive pulmonary disease (AECOPD), myocardial stress may be aggravated. Sparse data exist concerning the prevalence and correlates of cardiac arrhythmias in the stable and exacerbated states of COPD. We hypothesized that AECOPD is associated with increased prevalence of cardiac arrhythmias independent of COPD-severity and co-morbidity, and explored possible mechanisms. A 24-hour Holter recording was obtained in 74 patients with stable COPD and 45 patients with AECOPD (mean age 54 years, 56% women). Any incidence of supraventricular tachycardia (SVT), frequent premature ventricular complex (PVC, >30/hour) and complex ventricular ectopy (bigeminy, trigeminy or non-sustained ventricular tachycardia) was recorded and compared between the two groups. Adjustments were made for by stable disease-related co-variates (demography, co-morbidity, COPD-severity) and by acute disease-related co-variates (heart rate, cardiac troponin T (cTnT), PO2, PCO2and C-reactive protein (CRP)) in explorative analyses. The prevalence of SVT, frequent PVCs or complex ventricular ectopy was 40%, 27% and 33% in AECOPD, and 31%, 31% and 12% in stable COPD, respectively. Frequent PVC, but not SVT or complex ventricular ectopy, was significantly increased in AECOPD compared to stable COPD, odds ratio 3.03 (1.03-10.5, p = 0.039) when adjusted for stable disease-related co-variates. Higher heart rate, cTnT and CRP attenuated the association between AECOPD and frequent PVC to non-significant, while heart rate remained associated with frequent PVC. In conclusion, frequent PVC is more prevalent in exacerbated than in the stable states of COPD. Attenuation effects of cTnT, tachycardia and CRP suggest that cardiac stress or inflammation may be involved in mechanisms causing frequent PVC i AECOPD.
authors.affiliation: a Division of Medicine , Akershus University Hospital , Lørenskog , Norway.|b Center for Heart Failure Research , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Einvik
authors.affiliation: a Division of Medicine , Akershus University Hospital , Lørenskog , Norway.
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhatnagar
authors.affiliation: c LHL-klinikkene , Glittre, Hakadal , Norway.
authors.forename: Nils Henrik
authors.initials: NH
authors.lastname: Holmedahl
authors.affiliation: d Department of Radiology , Akershus University Hospital , Lørenskog , Norway.
authors.forename: Anke
authors.initials: A
authors.lastname: Neukamm
authors.affiliation: a Division of Medicine , Akershus University Hospital , Lørenskog , Norway.|b Center for Heart Failure Research , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.affiliation: a Division of Medicine , Akershus University Hospital , Lørenskog , Norway.
authors.forename: Vidar
authors.initials: V
authors.lastname: Søyseth
mesh_terms: D000208:Acute Disease; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000150:complications*; D013617:Tachycardia, Supraventricular / Q000097:blood / Q000209:etiology; D020107:Troponin T / Q000097:blood*; D018879:Ventricular Premature Complexes / Q000097:blood* / Q000209:etiology*
chemical_list: D020107:Troponin T; D002097:C-Reactive Protein
keywords: Acute exacerbation of COPD; cardiac arrhythmias; electrocardiography