Prevalence and Clinical Correlates of Radiologically Detected Coronary Artery Disease in COPD: A Cross-Sectional Observational Study.

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE

American journal of respiratory and critical care medicine Pub Date : 2024-12-16 DOI:10.1164/rccm.202404-0838OC

Mairi A MacLeod, Kristopher D Knott, James P Allinson, Lydia J Finney, Dexter J Wiseman, Andrew I Ritchie, Aaron Braddy-Green, Sam Barlett-Pestell, Ralph Lopez, Logan Sun, Philippa Webb, Paras Dalal, Michael Rubens, Simon Davies, Dorian O Haskard, Anand Devaraj, Gavin C Donaldson, Ramzi Y Khamis, Edward D Nicol, Jadwiga A Wedzicha

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引用次数: 0

Abstract

Rationale: Unrecognised coronary artery disease (CAD) may contribute to adverse outcomes in chronic obstructive pulmonary disease (COPD). Improved identification of at-risk groups could inform better preventative care. We aimed to evaluate the burden and relationships of radiologically detectable CAD in COPD, establish frequency of occult disease, and examine potential cardiovascular screening methods.

Methods: Using CT coronary angiogram (CTCA), we prospectively evaluated CAD in 50 patients with COPD compared to age, sex-matched controls. In those with COPD, the relationship of CAD to cardiac symptoms (chest pain, dyspnoea), functional capacity (six-minute walk), exacerbations and inflammation was assessed. The performance of screening tests (cardiovascular risk scores, biomarkers and CT thorax-derived coronary artery calcium score (CACS-Tx)) were evaluated using receiver operator curves.

Results: CAD was present in 88% of patients with COPD (42% had obstructive (≥50% stenosis of any vessel) and 28% severe obstructive (≥70%) disease). Rates of obstructive (OR 3·1 (95%CI 1·1-8·9) P=0·037) and severe obstructive CAD (OR 10·1(95%CI 1·9-52·7) P=0·006) were higher in COPD than controls. In the COPD group, those with CAD had greater functional impairments but not dyspnoea scores, and 75% reported no chest pain or prior IHD. CAD was more extensive in those with increased systemic inflammation (fibrinogen, c-reactive protein, leucocyte, and neutrophil count), bronchial wall thickening, and sputum bacterial growth but bore no relation to exacerbation frequency. CACS-Tx was an effective screening tool, with an area under the curve for CAD of 0·98 (95%CI 0·95-1·00) and obstructive CAD of 0·89 (95%CI 0·79-1·00).

Conclusions: CTCA-detected CAD is common in patients with COPD, correlating poorly with symptoms and risk scores. Radiological screening, using CT thorax, might improve detection and outcomes in this patient group.

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.