Skip to main content
SpringerLink
Log in

Impact of Left Ventricular Hypertrophy on Survival in Chronic Obstructive Pulmonary Disease

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

Left ventricular hypertrophy (LVH) is a significant cardiac risk factor, associated with increased mortality. The impact of LVH on mortality in chronic obstructive pulmonary disease (COPD) is unknown. We evaluated the impact of LVH on mortality in COPD patients by measurement of left ventricular dimensions by echocardiography.

Methods

Retrospective cohort study utilizing a NHS database of COPD patients (TARDIS), in Tayside, Scotland (2001–2010), linked with databases regarding echocardiograms, pharmacy prescription, and the General Register Office for Scotland death registry. Cox proportional hazard regression was used to determine hazard ratios for mortality and hospital admissions based upon left ventricular mass index (LVMI) and left ventricular internal diastolic diameter after correction for all available influential covariates. Increased LVIDd was defined as >5.3 cm (female) and >5.9 cm (male). LVH was defined as an LVMI of >95 g/m2 (female) and >115 g/m2 (male).

Results

617 patients were included for analysis. Mean (SD) age at diagnosis, 70 (9); mean FEV1 % (SD), 60.6 (19.3); mean resting SaO2 % (SD), 92.7 (10). Mean follow-up 4.5 years. Increased LVIDd was not associated with increased mortality, χ 2= 0.767, p = 0.381. Increased LVMI was associated with a significant increased risk of mortality, χ 2 = 5.447, p = 0.02 with an adjusted HR (95 % CI) of 1.542 (1.068–2.228), p = 0.021.

Conclusions

The presence of LVH, demonstrated by elevated left ventricular mass index is associated with a significantly increased risk of mortality in COPD patients. Therapeutic interventions are required to address this important modifiable risk factor in COPD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

COPD:

Chronic obstructive pulmonary disease

FEV1 :

Forced expiratory volume in one second

GOLD:

Global initiative for obstructive lung disease

HIC:

Health Informatics Centre

IVSTd:

Inter-ventricular septum thickness in diastole

LVIDd:

Left ventricular internal diastolic diameter

LVH:

Left ventricular hypertrophy

LVMI:

Left ventricular mass index

NHS:

National health service

TARDIS:

Tayside respiratory disease information system

PWTd:

Posterior wall thickness in diastole

References

  1. Sin DD, Man SF (2003) Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 107:1514–1519

    Article  PubMed  Google Scholar 

  2. Hurst JR, Vestbo J, Anzueto A et al (2010) Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 363:1128–1138

    Article  CAS  PubMed  Google Scholar 

  3. McAllister DA, Maclay JD, Mills NL et al (2012) Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. Eur Respir J 39:1097–1103

    Article  CAS  PubMed  Google Scholar 

  4. Report of the Medical Research Council Working Party (1981) Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1(8222):681–686

    Google Scholar 

  5. Nocturnal Oxygen Therapy Trial Group (1980) Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med 93(3):391–398

    Article  Google Scholar 

  6. Ang DS, Pringle SD, Struthers AD (2007) The cardiovascular risk factor, left ventricular hypertrophy, is highly prevalent in stable, treated angina pectoris. Am J Hypertens 20:1029–1035

    Article  PubMed  Google Scholar 

  7. Gosse P (2005) Left ventricular hypertrophy as a predictor of cardiovascular risk. J Hypertens Suppl 23:S27–S33

    Article  CAS  PubMed  Google Scholar 

  8. Liao Y, Cooper RS, McGee DL et al (1995) The relative effects of left ventricular hypertrophy, coronary artery disease, and ventricular dysfunction on survival among black adults. JAMA 273:1592–1597

    Article  CAS  PubMed  Google Scholar 

  9. Benjamin EJ, D’Agostino RB, Belanger AJ et al (1995) Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation 92:835–841

    Article  CAS  PubMed  Google Scholar 

  10. Fuso L, Incalzi RA, Pistelli R et al (1995) Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 98:272–277

    Article  CAS  PubMed  Google Scholar 

  11. Short P, Chalmers J, Akram A et al (2012) Impact of tachycardia and new onset atrial fibrillation in acute exacerbations of COPD. Thorax 67:A158–A159

    Article  Google Scholar 

  12. Jensen MT, Marott JL, Lange P et al (2013) Resting heart rate is a predictor of mortality in COPD. Eur Respir J 42:341–349

    Article  PubMed  Google Scholar 

  13. Anderson WJ, Lipworth BJ, Rekhraj S et al (2013) Left ventricular hypertrophy in COPD without hypoxemia: the elephant in the room? Chest 143:91–97

    Article  PubMed  Google Scholar 

  14. Schembri S, Anderson W, Morant S et al (2009) A predictive model of hospitalisation and death from chronic obstructive pulmonary disease. Respir Med 103:1461–1467

    Article  PubMed  Google Scholar 

  15. Short PM, Lipworth SI, Elder DH et al (2011) Effect of beta blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. BMJ 342:d2549

    Article  PubMed Central  PubMed  Google Scholar 

  16. Devereux RB, Alonso DR, Lutas EM et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    Article  CAS  PubMed  Google Scholar 

  17. Foppa M, Duncan BB, Rohde LE (2005) Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound 3:17

    Article  PubMed Central  PubMed  Google Scholar 

  18. Lang RM, Bierig M, Devereux RB et al (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108

    Article  PubMed  Google Scholar 

  19. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Executive Summary. (Updated 2009) Global Initiative for Chronic Obstructive Lung Disease. http://www.goldcopd.com. Accessed 01 June 2014

  20. Chang CL, Robinson SC, Mills GD et al (2011) Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax 66:764–768

    Article  PubMed  Google Scholar 

  21. Smith BM, Kawut SM, Bluemke DA et al (2013) Pulmonary hyperinflation and left ventricular mass: the multi-ethnic study of atherosclerosis COPD Study. Circulation 127:1503–1511 1511e1501–1506

    Article  PubMed Central  PubMed  Google Scholar 

  22. Devereux RB, Wachtell K, Gerdts E et al (2004) Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA 292:2350–2356

    Article  CAS  PubMed  Google Scholar 

  23. Okin PM, Devereux RB, Gerdts E et al (2006) Impact of diabetes mellitus on regression of electrocardiographic left ventricular hypertrophy and the prediction of outcome during antihypertensive therapy: the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study. Circulation 113:1588–1596

    Article  CAS  PubMed  Google Scholar 

  24. Rekhraj S, Gandy SJ, Szwejkowski BR et al (2013) High-dose allopurinol reduces left ventricular mass in patients with ischemic heart disease. J Am Coll Cardiol 61:926–932

    Article  CAS  PubMed  Google Scholar 

  25. Szwejkowski BR, Gandy SJ, Rekhraj S et al (2013) Allopurinol reduces left ventricular mass in patients with type 2 diabetes and left ventricular hypertrophy. J Am Coll Cardiol 62:2284–2293

    Article  CAS  PubMed  Google Scholar 

  26. Barr RG, Bluemke DA, Ahmed FS et al (2010) Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med 362:217–227

    Article  PubMed Central  PubMed  Google Scholar 

  27. Dallari R, Barozzi G, Pinelli G et al (1994) Predictors of survival in subjects with chronic obstructive pulmonary disease treated with long-term oxygen therapy. Respiration 61:8–13

    Article  CAS  PubMed  Google Scholar 

  28. Delgado-Rodriguez M, Llorca J (2004) Bias. J Epidemiol Community Health 58:635–641

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by University of Dundee.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, Scotland, UK

    Philip M. Short, William J. Anderson & Brian J. Lipworth

  2. Department of Cardiology, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK

    Douglas H. J. Elder

  3. Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, Scotland, UK

    Allan D. Struthers

Authors
  1. Philip M. Short
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William J. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Douglas H. J. Elder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Allan D. Struthers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian J. Lipworth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian J. Lipworth.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Short, P.M., Anderson, W.J., Elder, D.H.J. et al. Impact of Left Ventricular Hypertrophy on Survival in Chronic Obstructive Pulmonary Disease. Lung 193, 487–495 (2015). https://doi.org/10.1007/s00408-015-9724-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-015-9724-8

Keywords

Search

Navigation