Martin Eichenlaub, Björn Christian Frye, Heiko Lehrmann, Frank Biertz, Amir Sherwan Jadidi, Klaus Kaier, Thomas Melzer, Peter Alter, Henrik Watz, Benjamin Waschki, Barbara Christine Weckler, Franziska Christina Trudzinski, Julia Dorothea Michels-Zetsche, Frederik Trinkmann, Felix Josef-Friedrich Herth, Hans-Ulrich Kauczor, Kathrin Kahnert, Rudolf Jörres, Robert Bals, Dirk Westermann, Thomas Arentz, Claus Franz Vogelmeier, Daiana Stolz, Sebastian Fähndrich
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We aimed to identify patients at risk for AF using amplified p-wave duration (APWD) analysis on electrocardiogram (ECG) as non-invasive tool to diagnose an atrial cardiomyopathy (AtCM) which is an established risk factor for AF.</p><p><strong>Methods: </strong>This subgroup analysis of the prospective COSYCONET cohort included 2,385 COPD patients from 31 study centers with baseline sinus rhythm ECG and at least one follow-up examination. Of these, 73 patients showed AF during follow-up and were propensity-score matched to controls. APWD was measured at baseline and future major adverse cardiac and cerebrovascular events (MACCE) and health related outcome were assessed.</p><p><strong>Results: </strong>219 COPD patients (70 [64-74] years, 79.5% male) were analyzed during a follow-up of 586 (210-1137) days. APWD was significantly longer in patients with AF occurrence compared to controls (132 [125-141] ms vs. 124 [117-133] ms, p < 0.001) and remained significant in multivariate regression analysis (OR: 1.05 [1.01-1.09], p = 0.03). An APWD ≥ 131 ms was identified as best cut-off for AF prediction (62% sensitivity, 70% specificity, OR: 3.91 [2.58 to 5.95], p < 0.001). Patients with AF had a significantly higher MACCE rate (24.7% versus 8.2%, p = 0.001) and a significantly lower physical activity score (1,074 [264-4,776] vs. 2,706 [975-7,339], p = 0.008).</p><p><strong>Conclusions: </strong>This study demonstrates that ECG-based AtCM diagnosis identifies COPD patients at risk for AF, which was associated with a substantially elevated MACCE rate and a significantly reduced physical activity. This easy, cost-effective and widely available digital biomarker might enable early therapy initiation and prevention of adverse clinical outcomes.</p><p><strong>Trial registration: </strong>NCT01245933 on Clinical-Trials.gov (Registration date: 22.11.2010).</p>","PeriodicalId":49131,"journal":{"name":"Respiratory Research","volume":"26 1","pages":"272"},"PeriodicalIF":5.8000,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442265/pdf/","citationCount":"0","resultStr":"{\"title\":\"ECG-based identification of COPD patients at risk for atrial fibrillation and its impact on adverse clinical outcomes-a subgroup analysis of the prospective multicenter COSYCONET cohort.\",\"authors\":\"Martin Eichenlaub, Björn Christian Frye, Heiko Lehrmann, Frank Biertz, Amir Sherwan Jadidi, Klaus Kaier, Thomas Melzer, Peter Alter, Henrik Watz, Benjamin Waschki, Barbara Christine Weckler, Franziska Christina Trudzinski, Julia Dorothea Michels-Zetsche, Frederik Trinkmann, Felix Josef-Friedrich Herth, Hans-Ulrich Kauczor, Kathrin Kahnert, Rudolf Jörres, Robert Bals, Dirk Westermann, Thomas Arentz, Claus Franz Vogelmeier, Daiana Stolz, Sebastian Fähndrich\",\"doi\":\"10.1186/s12931-025-03342-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Atrial fibrillation (AF) frequently occurs in patients with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes. We aimed to identify patients at risk for AF using amplified p-wave duration (APWD) analysis on electrocardiogram (ECG) as non-invasive tool to diagnose an atrial cardiomyopathy (AtCM) which is an established risk factor for AF.</p><p><strong>Methods: </strong>This subgroup analysis of the prospective COSYCONET cohort included 2,385 COPD patients from 31 study centers with baseline sinus rhythm ECG and at least one follow-up examination. Of these, 73 patients showed AF during follow-up and were propensity-score matched to controls. APWD was measured at baseline and future major adverse cardiac and cerebrovascular events (MACCE) and health related outcome were assessed.</p><p><strong>Results: </strong>219 COPD patients (70 [64-74] years, 79.5% male) were analyzed during a follow-up of 586 (210-1137) days. APWD was significantly longer in patients with AF occurrence compared to controls (132 [125-141] ms vs. 124 [117-133] ms, p < 0.001) and remained significant in multivariate regression analysis (OR: 1.05 [1.01-1.09], p = 0.03). An APWD ≥ 131 ms was identified as best cut-off for AF prediction (62% sensitivity, 70% specificity, OR: 3.91 [2.58 to 5.95], p < 0.001). Patients with AF had a significantly higher MACCE rate (24.7% versus 8.2%, p = 0.001) and a significantly lower physical activity score (1,074 [264-4,776] vs. 2,706 [975-7,339], p = 0.008).</p><p><strong>Conclusions: </strong>This study demonstrates that ECG-based AtCM diagnosis identifies COPD patients at risk for AF, which was associated with a substantially elevated MACCE rate and a significantly reduced physical activity. 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引用次数: 0
摘要
背景：心房颤动（AF）常见于慢性阻塞性肺疾病（COPD）患者，并与不良临床结果相关。我们的目的是通过心电图（ECG）的放大p波持续时间（APWD）分析来识别有AF风险的患者，作为诊断心房心肌病（AtCM）的无创工具，心房心肌病是AF的既定危险因素。方法：前瞻性COSYCONET队列的亚组分析包括来自31个研究中心的2,385名COPD患者，他们有基线窦性心律心电图和至少一次随访检查。其中，73例患者在随访期间出现房颤，倾向评分与对照组相符。在基线时测量APWD，并评估未来主要心脑血管不良事件（MACCE）和健康相关结局。结果：219例COPD患者（70[64-74]岁，79.5%为男性）在586（210-1137）天的随访中被分析。与对照组相比，房颤患者APWD时间明显延长（132 [125-141]ms vs. 124 [117-133] ms）。结论：本研究表明，基于ecg的AtCM诊断可识别有房颤风险的COPD患者，这与MACCE率显著升高和体力活动显著减少相关。这种简单、经济、广泛使用的数字生物标志物可能使早期治疗开始和预防不良临床结果成为可能。试验注册：临床试验网站NCT01245933（注册日期：2010年11月22日）。
ECG-based identification of COPD patients at risk for atrial fibrillation and its impact on adverse clinical outcomes-a subgroup analysis of the prospective multicenter COSYCONET cohort.
Background: Atrial fibrillation (AF) frequently occurs in patients with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes. We aimed to identify patients at risk for AF using amplified p-wave duration (APWD) analysis on electrocardiogram (ECG) as non-invasive tool to diagnose an atrial cardiomyopathy (AtCM) which is an established risk factor for AF.
Methods: This subgroup analysis of the prospective COSYCONET cohort included 2,385 COPD patients from 31 study centers with baseline sinus rhythm ECG and at least one follow-up examination. Of these, 73 patients showed AF during follow-up and were propensity-score matched to controls. APWD was measured at baseline and future major adverse cardiac and cerebrovascular events (MACCE) and health related outcome were assessed.
Results: 219 COPD patients (70 [64-74] years, 79.5% male) were analyzed during a follow-up of 586 (210-1137) days. APWD was significantly longer in patients with AF occurrence compared to controls (132 [125-141] ms vs. 124 [117-133] ms, p < 0.001) and remained significant in multivariate regression analysis (OR: 1.05 [1.01-1.09], p = 0.03). An APWD ≥ 131 ms was identified as best cut-off for AF prediction (62% sensitivity, 70% specificity, OR: 3.91 [2.58 to 5.95], p < 0.001). Patients with AF had a significantly higher MACCE rate (24.7% versus 8.2%, p = 0.001) and a significantly lower physical activity score (1,074 [264-4,776] vs. 2,706 [975-7,339], p = 0.008).
Conclusions: This study demonstrates that ECG-based AtCM diagnosis identifies COPD patients at risk for AF, which was associated with a substantially elevated MACCE rate and a significantly reduced physical activity. This easy, cost-effective and widely available digital biomarker might enable early therapy initiation and prevention of adverse clinical outcomes.
Trial registration: NCT01245933 on Clinical-Trials.gov (Registration date: 22.11.2010).
期刊介绍：
Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases.
As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion.
Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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