Abstract
Chronic obstructive pulmonary disease (COPD) primarily affects the lungs; however, cardiovascular conditions are among the most common extrapulmonary comorbidities. Besides shared risk factors such as cigarette smoking, pathophysiological connections between the lung and the heart have been identified as mediators of reduced cardiac output. Recent research has focused on hyperinflation of the lung as a pulmonary cause for heart dysfunction. Hyperinflation is a typical lung abnormality seen in COPD; it is characterized by increased residual volume, intrathoracic gas volume, and total lung capacity while vital capacity is decreased. The degree of hyperinflation with airway obstruction is inversely related to left ventricular filling, stroke volume, and cardiac output. The underlying mechanisms are assumed to be compression of the pulmonary veins and thus reduced preload of the left heart as well as decreased pulmonary microvascular blood flow due to compression of the pulmonary vasculature. Treatment with a dual bronchodilator antagonizes this detrimental lung–heart unbalance effectively: Pulmonary blood flow, left ventricular end-diastolic volume, and stroke volume increase in COPD patients without cardiac abnormalities. Similar effects, yet less pronounced, were reported with single bronchodilator therapy. Future work needs to investigate whether these promising findings can be reproduced in COPD patients with cardiovascular diseases.
Zusammenfassung
Die chronisch obstruktive Lungenkrankheit (COPD) betrifft in erster Linie die Atemwege, kardiovaskuläre Erkrankungen zählen jedoch zu den häufigsten Komorbiditäten. Neben gemeinsamen Risikofaktoren wie dem Rauchen tragen zusätzlich pathophysiologische Wechselwirkungen zwischen Lunge und Herz zu einer verringerten kardialen Auswurfleistung bei. Die aktuelle Forschung konzentriert sich v. a. auf die Lungenüberblähung als Ursache für eine reduzierte Herzleistung bei Patienten mit COPD. Die Überblähung ist eine für die COPD typische pulmonale Funktionsabweichung, die durch ein erhöhtes Residualvolumen, intrathorakales Gasvolumen und eine vergrößerte totale Lungenkapazität bei erniedrigter Vitalkapazität charakterisiert ist. Das Verhältnis zwischen dem Grad der Überblähung und linksventrikulärem enddiastolischem Volumen, Schlagvolumen und Auswurfleistung ist umgekehrt proportional. Dem zugrunde liegen vermutlich erstens eine Kompression der Pulmonalvenen, die zu einer verringerten linksventrikulären Vorlast führt, und zweitens eine Kompression des pulmonalen Kapillarbetts, die einen verminderten pulmonalen mikrovaskulären Blutfluss zur Folge hat. Die Behandlung mit einem dualen Bronchodilatator korrigiert dieses Ungleichgewicht zwischen Lunge und Herz in eine günstige Richtung: Pulmonaler Blutfluss, linksventrikuläres enddiastolisches Volumen und Schlagvolumen erhöhen sich bei überblähten COPD-Patienten ohne kardiale Vorerkrankungen. Ähnliche Effekte, jedoch schwächer ausgeprägt, lassen sich mit einer einfachen bronchienerweiternden Therapie erreichen. Eine zukünftige Forschungsaufgabe liegt darin zu untersuchen, ob sich ähnlich positive Ergebnisse bei COPD-Patienten mit kardiovaskulären Erkrankungen erzielen lassen.
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J. Bauersachs’s, T. Welte’s and J.M. Hohlfeld’s institutions received grant support for conducting clinical studies on the impact of dual bronchodilation in COPD patients by Novartis Pharma GmbH. Moreover, they received personal honoraria for advisory boards and lectures from Novartis Pharma GmbH. N. Struß declares that she has no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.
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Struß, N., Bauersachs, J., Welte, T. et al. Left heart function in COPD. Herz 44, 477–482 (2019). https://doi.org/10.1007/s00059-019-4816-5
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DOI: https://doi.org/10.1007/s00059-019-4816-5
Keywords
- Pulmonary disease, chronic obstructive
- Hyperinflation
- Bronchodilator effect
- Left ventricular function
- Cardiovascular disease