natriuretic-peptide--brain and Airway-Obstruction

Chronic obstructive pulmonary disease and heart failure (HF) are 2 diseases with high morbidity and mortality. The coexistence of these two diseases is estimated to be frequent, but has been poorly studied.. To study the prevalence of airflow limitation in a sample of patients diagnosed with HF in follow-up in an HF unit and to assess their characteristics and comorbidities.. This is a prospective observational study. The patients who visited the HF Unit of the Hospital Universitari Germans Trias i Pujol between January 2014 and June 2015 were included consecutively. Respiratory functional tests were performed and clinical data were obtained.. 118 patients were included in the study (age 67.2 years, 77.1% men). The prevalence of non-reversible airflow obstruction was 36.4%, with an underdiagnosis percentage of 67.4%. Patients with airflow limitation had an increase in comorbidities, but no worse prognosis.. The prevalence of airflow limitation in patients with HF is high, with a significant degree of underdiagnosis. It seems reasonable to recommend performing a screening spirometry in these patients.

Topics: Aged; Aged, 80 and over; Airway Obstruction; Biomarkers; Cause of Death; Comorbidity; Delayed Diagnosis; Female; Forced Expiratory Volume; Heart Failure; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Smoking; Spirometry

The association between lung function and cardiac markers and heart failure (HF) has been little studied in the general older population. We have examined the association between lung function and airway obstruction with cardiac markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) and risk of incident HF in older men.. Prospective study of 3242 men aged 60-79 years without prevalent HF or myocardial infarction followed up for an average period of 13 years, in whom 211 incident HF cases occurred. Incident HF was examined in relation to % predicted FEV1 and FVC. The Global Initiative on Obstructive Lung Diseases spirometry criteria were used to define airway obstruction. Reduced FEV1, but not FVC in the normal range, was significantly associated with increased risk of HF after adjustment for established HF risk factors including inflammation. The adjusted HRs comparing men in the 6-24th percentile with the highest quartile were 1.91 (1.24 to 2.94) and 1.30 (0.86 to 1.96) for FEV1 and FVC, respectively. FEV1 and FVC were inversely associated with NT-proBNP and cTnT, although the association between FEV1 and incident HF remained after adjustment for NT-proBNP and cTnT. Compared with normal subjects (FEV1/FVC ≥0.70 and FVC≥80%), moderate or severe (FEV1/FVC <0.70 and FEV1 <80%) airflow obstruction was independently associated with HF ((adjusted relative risk 1.59 (1.08 to 2.33)). Airflow restriction (FEV1/FVC ≥0.70 and FVC <80%) was not independently associated with HF.. Reduced FEV1 reflecting airflow obstruction is associated with cardiac dysfunction and increased risk of incident HF in older men.

Topics: Aged; Airway Obstruction; Biomarkers; Electrocardiography; England; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Respiratory Function Tests; Surveys and Questionnaires; Troponin T

While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients. We used a prospective cohort study including stable ≥ 60-yr-old patients with echocardiographically confirmed CHF (n=201) and stable ≥ 60-yr-old patients with clinically and spirometry-confirmed COPD (n=218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs. The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p=0.053). The presence of airway obstruction in patients with CHF did not influence survival. CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients.

Topics: Aged; Airway Obstruction; Argentina; Cardiology; Cohort Studies; Comorbidity; Echocardiography; Electrocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Registries; Spirometry; Ventricular Dysfunction, Left

Chronic pulmonary disorders, such as chronic obstructive pulmonary disease (COPD) and fibrosing lung diseases, and atrial fibrillation (AF), are prevalent in elderly people. The impact of cardiac co-morbidities in the elderly, where pulmonary function is impaired, cannot be ignored as they influence mortality. The relationship between the prevalence of AF and pulmonary function is unclear. The aim of this study was to evaluate this relationship in participants in a health check.. Subjects aged 40 or older (n = 2,917) who participated in a community-based annual health check in Takahata, Japan, from 2004 through to 2005, were enrolled in the study. We performed blood pressure measurements, blood sampling, electrocardiograms, and spirometry on these subjects.. The mean FEV(1) % predicted and FVC % predicted in AF subjects was significantly lower than in non-AF subjects. The prevalence of AF was higher in those subjects with airflow limitation or lung restriction than in those without. Furthermore, AF prevalence was higher in those subjects with severe airflow obstruction (FEV(1) %predicted < 50) than in those who had mild or moderate airflow obstruction (FEV(1) %predicted ≥ 50), although there was no difference between the prevalence of AF in subjects with 70≤ FVC %predicted <80 lung restriction and those with FVC %predicted <70. Multiple logistic regression analysis revealed that FEV(1) %predicted and FVC %predicted are independent risk factors for AF (independent of age, gender, left ventricular hypertrophy, and serum levels of B-type natriuretic peptide).. Impaired pulmonary function is an independent risk factor for AF in the Japanese general population.

Topics: Adult; Aged; Airway Obstruction; Atrial Fibrillation; C-Reactive Protein; Electrocardiography; Female; Forced Expiratory Volume; Humans; Hypertension; Inflammation; Japan; Lung; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prevalence; Risk Factors; Smoking; Spirometry; Vital Capacity

Patients with impaired lung function often have systemic inflammation. C-reactive protein (CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are markers for inflammation and cardiac stress, respectively.. To evaluate the association between both markers and the potential impacts of lung disease on this relationship.. CRP and NT-proBNP were prospectively measured in 697 consecutive outpatients (57.5 +/- 16.4 years) with chronic dyspnea. The patients were stratified into quartiles according to CRP levels (quartile 1: median CRP 0.35 mg/l; quartile 2: 1.50 mg/l; quartile 3: 3.62 mg/l; quartile 4: 10.90 mg/l) and classified into 2 categories based on the presence (n = 176) or absence (n = 521) of heart disease.. Patients with at least moderately severe airway obstruction and those with interstitial lung disease had higher CRP values than patients without lung disease (median 3.50 vs. 4.34 vs. 1.80 mg/l, respectively; p < 0.01). In patients without heart disease, NT-proBNP values increased from CRP quartiles 1-3 to quartile 4 (median 47.4 vs. 82.1 pg/ml; p < 0.01) after adjusting for important covariates such as age, sex, body mass index, renal function and arterial hypertension. Likewise, the values for NT-proBNP were lower in CRP quartiles 1-3 than in quartile 4 (median 212.0 vs. 647.7 pg/ml; p < 0.01) in patients with heart disease after additional adjustment for the type of cardiac disorder. Lung disease had no direct effect on the relationship between CRP and NT-proBNP.. Systemic inflammation that originates in the lung places an excess burden on the heart, which may contribute to the functional impairment of patients with advanced pulmonary disease.

Topics: Airway Obstruction; Biomarkers; C-Reactive Protein; Dyspnea; Female; Forced Expiratory Volume; Heart Diseases; Humans; Lung Diseases; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Severity of Illness Index

Appreciation of the anti-inflammatory actions of theophylline at low serum concentrations has revived the interest in this drug, but its cardiac side effects remain a concern. The serum level of N-terminal probrain natriuretic peptide (NT-proBNP) is a marker for cardiac stress. This study examined the association between theophylline intake and NT-proBNP.. The effect of theophylline on NT-proBNP was prospectively evaluated by multiple regression analysis in 753 outpatients referred for pulmonary evaluation of dyspnea.. Of 548 patients with asthma, chronic obstructive pulmonary disease or respiratory muscle weakness, 107 were taking theophylline (median serum concentration 8.1 μg/ml). The theophylline users were older (mean 64.5 ± 11.6 vs. 56.5 ± 16.8 years, p < 0.01), had severer airway obstruction (p < 0.01) and had a higher prevalence of heart disease (33.6 vs. 23.1%, p = 0.02) than the patients not taking theophylline. Among the patients with heart disease (n = 138), the adjusted levels of NT-proBNP were lower (p < 0.01) in the theophylline-treated patients (n = 36) than in the patients not using theophylline (median 144.5 vs. 236.4 pg/ml). Theophylline had no effect on NT-proBNP in patients without heart disease.. The results of this observational study call into question the traditional view that even low-dose theophylline therapy may be detrimental in patients with coexisting heart disease.

Topics: Adult; Age Factors; Aged; Airway Obstruction; Bronchodilator Agents; Dyspnea; Female; Heart Diseases; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prevalence; Prospective Studies; Regression Analysis; Severity of Illness Index; Theophylline

Topics: Airway Obstruction; Diagnosis, Differential; Echocardiography; Electrocardiography; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Edema; Radiography, Thoracic