Prevalence and Clinical Correlates of Radiologically Detected Coronary Artery Disease in COPD: A Cross-Sectional Observational Study.

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE American journal of respiratory and critical care medicine Pub Date : 2024-12-16 DOI:10.1164/rccm.202404-0838OC

Mairi A MacLeod, Kristopher D Knott, James P Allinson, Lydia J Finney, Dexter J Wiseman, Andrew I Ritchie, Aaron Braddy-Green, Sam Barlett-Pestell, Ralph Lopez, Logan Sun, Philippa Webb, Paras Dalal, Michael Rubens, Simon Davies, Dorian O Haskard, Anand Devaraj, Gavin C Donaldson, Ramzi Y Khamis, Edward D Nicol, Jadwiga A Wedzicha

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Abstract

Rationale: Unrecognised coronary artery disease (CAD) may contribute to adverse outcomes in chronic obstructive pulmonary disease (COPD). Improved identification of at-risk groups could inform better preventative care. We aimed to evaluate the burden and relationships of radiologically detectable CAD in COPD, establish frequency of occult disease, and examine potential cardiovascular screening methods.

Methods: Using CT coronary angiogram (CTCA), we prospectively evaluated CAD in 50 patients with COPD compared to age, sex-matched controls. In those with COPD, the relationship of CAD to cardiac symptoms (chest pain, dyspnoea), functional capacity (six-minute walk), exacerbations and inflammation was assessed. The performance of screening tests (cardiovascular risk scores, biomarkers and CT thorax-derived coronary artery calcium score (CACS-Tx)) were evaluated using receiver operator curves.

Results: CAD was present in 88% of patients with COPD (42% had obstructive (≥50% stenosis of any vessel) and 28% severe obstructive (≥70%) disease). Rates of obstructive (OR 3·1 (95%CI 1·1-8·9) P=0·037) and severe obstructive CAD (OR 10·1(95%CI 1·9-52·7) P=0·006) were higher in COPD than controls. In the COPD group, those with CAD had greater functional impairments but not dyspnoea scores, and 75% reported no chest pain or prior IHD. CAD was more extensive in those with increased systemic inflammation (fibrinogen, c-reactive protein, leucocyte, and neutrophil count), bronchial wall thickening, and sputum bacterial growth but bore no relation to exacerbation frequency. CACS-Tx was an effective screening tool, with an area under the curve for CAD of 0·98 (95%CI 0·95-1·00) and obstructive CAD of 0·89 (95%CI 0·79-1·00).

Conclusions: CTCA-detected CAD is common in patients with COPD, correlating poorly with symptoms and risk scores. Radiological screening, using CT thorax, might improve detection and outcomes in this patient group.

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慢性阻塞性肺病患者放射学检测到的冠状动脉疾病的患病率和临床相关性：一项横断面观察研究。

理由：未被识别的冠状动脉疾病（CAD）可能导致慢性阻塞性肺疾病（COPD）的不良结局。改进对高危人群的识别可以为更好的预防保健提供信息。我们的目的是评估慢性阻塞性肺疾病中可检测到的CAD的负担和关系，建立隐匿性疾病的频率，并研究潜在的心血管筛查方法。方法：采用CT冠状动脉造影（CTCA）对50例COPD患者的CAD进行前瞻性评估，并与年龄、性别匹配的对照组进行比较。在COPD患者中，评估CAD与心脏症状（胸痛、呼吸困难）、功能能力（步行6分钟）、加重和炎症的关系。筛选试验（心血管风险评分、生物标志物和CT胸源性冠状动脉钙评分（CACS-Tx））的性能使用接受者算子曲线进行评估。结果：88%的COPD患者存在CAD（42%有阻塞性（任何血管狭窄≥50%），28%有严重阻塞性（≥70%）疾病）。COPD患者的阻塞性冠心病（OR 3.1 (95%CI 1.1 ~ 8.9) P= 0.037）和重度阻塞性冠心病（OR 10.1 (95%CI 1.9 ~ 52.7) P= 0.006）发生率均高于对照组。在COPD组中，CAD患者有更大的功能障碍，但没有呼吸困难评分，75%的患者报告没有胸痛或IHD病史。CAD在全身性炎症（纤维蛋白原、c反应蛋白、白细胞和中性粒细胞计数）、支气管壁增厚和痰细菌生长增加的患者中更为广泛，但与恶化频率无关。CACS-Tx是有效的筛查工具，CAD曲线下面积为0.98 (95%CI 0.95 - 1.00)，阻塞性CAD曲线下面积为0.89 （95%CI 0.79 - 1.00）。结论：ctca检测到的CAD在COPD患者中很常见，但与症状和风险评分相关性较差。胸部CT放射学筛查可提高本组患者的检出率和预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.