ECG-based risk factors for adverse cardiopulmonary events and treatment outcomes in COPD.

IF 16.6 1区医学 Q1 RESPIRATORY SYSTEM European Respiratory Journal Pub Date : 2024-11-21 DOI:10.1183/13993003.00171-2024

R Chad Wade, Fernando J Martinez, Gerard J Criner, Lee Tombs, David A Lipson, David M G Halpin, MeiLan K Han, Dave Singh, Robert A Wise, Ravi Kalhan, Mark T Dransfield

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Abstract

Background: COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two electrocardiogram (ECG) markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD.

Methods: Post hoc analysis of the IMPACT trial. Outcomes included odds (odds ratio [95% confidence intervals]) of adverse cardiopulmonary events stratified by CIIS threshold (<20/≥20) and P pulmonale (baseline). Events included all-cause death, hospitalisation/death, cardiovascular adverse event of special interest (CVAESI), severe COPD exacerbations, and moderate/severe COPD exacerbations. Effects of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus FF/VI or UMEC/VI based on CIIS and P pulmonale were also assessed.

Results: We included 9448 patients. Patients with CIIS ≥20 had greater odds of all-cause death (1.73[1.27-2.37]; p<0.001), hospitalisation/death (1.33[1.17-1.50]; p<0.001), CVAESI (1.27[1.08-1.48]; p<0.005), severe COPD exacerbations (1.41[1.21-1.64]; p<0.001) and moderate/severe COPD exacerbations (1.25[1.13-1.40]; p<0.001) versus CIIS <20. Patients with P pulmonale (versus without) had greater odds of all-cause death (2.25[1.54-3.29]; p<0.001), hospitalisation/death (1.51[1.28-1.79]; p<0.001), severe COPD exacerbations (2.00[1.65-2.41]; p<0.001) and moderate/severe COPD exacerbations (1.25[1.08-1.46]; p<0.001). A combined model demonstrated patients with CIIS ≥20 and P pulmonale had increased risk of all-cause death (3.38[1.23-9.30]; p=0.019), hospitalisation/death (1.61[1.14-2.22]; p=0.004), and rate of severe COPD exacerbations (1.89[1.22-2.91]; p=0.004) and moderate/severe COPD exacerbations (1.25[1.00-1.56]; p=0.046). The risk of all-cause death and CVAESI was reduced with FF/UMEC/VI versus UMEC/VI in patients with CIIS ≥20, but not CIIS <20.

Conclusions: These findings suggest potential clinical relevance of CIIS and P pulmonale as risk indicators for adverse cardiopulmonary events in COPD.

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基于心电图的慢性阻塞性肺病不良心肺事件风险因素和治疗效果。

背景：慢性阻塞性肺病的死亡率很高，并发心血管疾病更是雪上加霜。我们研究了心肌梗塞损伤评分（CIIS）和肺动脉高压这两个心电图（ECG）指标，将其作为慢性阻塞性肺病不良心肺事件的预后工具：方法：对 IMPACT 试验进行事后分析。结果包括按CIIS阈值分层的不良心肺事件几率（几率比[95%置信区间]）（与基于CIIS和肺动脉高压的FF/VI或UMEC/VI相比）：我们纳入了 9448 例患者。CIIS≥20的患者全因死亡的几率更高（1.73[1.27-2.37]；ppppp相对于CIIS与无CIIS的患者），CIIS≥20但无CIIS的患者全因死亡的几率更高（2.25[1.54-3.29]；ppppp相对于UMEC/VI的患者）：这些研究结果表明，CIIS 和肺心病是慢性阻塞性肺疾病不良心肺事件的风险指标，具有潜在的临床意义。

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来源期刊

European Respiratory Journal 医学-呼吸系统

CiteScore

27.50

自引率

3.30%

发文量

345

审稿时长

2-4 weeks

期刊介绍： The European Respiratory Journal (ERJ) is the flagship journal of the European Respiratory Society. It has a current impact factor of 24.9. The journal covers various aspects of adult and paediatric respiratory medicine, including cell biology, epidemiology, immunology, oncology, pathophysiology, imaging, occupational medicine, intensive care, sleep medicine, and thoracic surgery. In addition to original research material, the ERJ publishes editorial commentaries, reviews, short research letters, and correspondence to the editor. The articles are published continuously and collected into 12 monthly issues in two volumes per year.