Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia
*Corresponding author: Olesya V. Melnichenko, PhD, Department of Internal Medicine, Nizhny Novgorod State Medical Academy, 6-58, Trudovaya str., 603155, Nizhny Novgorod, Russian Federation. Tel.: 7-831-436-9976, Fax: 7-831-436-9976. E-mail: firstname.lastname@example.org
Background: It is well established that atrial fibrillation (AF) could develop in patients with chronic obstructive pulmonary disease (COPD); however, its predictors are not quite clear. The aim of this study was to investigate the cardiovascular, hormonal and bronchial obstruction markers and their possible relation to AF risk in COPD.
Methods: Echocardiographic data, resting pulmonary artery mean pressure (PAP) by Doppler ultrasound assessment, N-terminal B-type natriuretic peptide NT-pro-BNP), aldosteronee levels, plasma renin activity, and spirometry parameters in 153 patients with COPD was carefully studied. During follow up, between 8 and 26 months, 18 patients developed an outcome event of atrial fibrillation (AF).
Results: On univariate analysis, renin activity (p=0.007), left atrium (p=0.015), right atrium (p=0.028) and right ventricle (p=0.001), left ventricle systolic (p=0.012) and diastolic (p=0.010) diameters were noted to be predictors of AF, although PAP, NT-pro-BNP levels or FEV1 (p>0.05) were not. However, on multivariate analysis, renin activity (1.14 [1.03; 1.24], p=0.006) and right ventricular diameter (1.39 [1.11; 1.72], p=0.003) were found to be AF predictors.
Conclusion: The plasma rennin activity and right ventricular diameter were found to be the most reliable markers of AF risk in COPD patients from among all the investigated echocardiographic and biochemical parameters.
1. Wei ZM, Cai JF, Cui H, Liu AM, Li Y, Gao F et al. Retrospective study on the prevalence of cardiovascular comorbidities in 4960 inpatients with chronic obstructive pulmonary disease in Beijing. Zhonghua Liu Xing Bing Xue Za Zhi 2011; 32(3):297-301.
2. Preobrazhenskiĭ DV, Talyzina IV, Sidorenko BA, Nekrasova NI, Vyshinskaia IV. Right ventricular cardiac failure in hospitalized patients with chronic obstructive pulmonary disease: prevalence and clinical and instrumental characteristics. Kardiologiia 2009; 49(7-8):42-5.
3. Christiansen CF, Christensen S, Mehnert F, Cummings SR, Chapurlat RD, Sørensen HT. Glucocorticoid use and risk of atrial fibrillation or flutter: a population-based, case-control study. Arch Intern Med 2009; 169 (18):1677-83.
4. Fabbian F, De Giorgi A, Pala M, Tiseo R, Portaluppi F. Elevated NT-proBNP levels should be interpreted in elderly patients presenting with dyspnea. Eur J Intern Med 2011; 22(1):108-11.
5. Hanrahan JP, Grogan DR, Baumgartner RA, Wilson A, Cheng H, Zimetbaum PJ, et al. Arrhythmias in patients with chronic obstructive pulmonary disease (COPD): occurrence frequency and the effect of treatment with the inhaled long-acting beta2-agonists arformoterol and salmeterol. Medicine (Baltimore) 2008; 87(6): 319-28.
6. Sánchez-Marteles M, Cecilio-Irazola A, Vañó-Sanchis D, Nuviala-Mateo R, Serrano-Martínez S, Pérez-Calvo JJ. NT-proBNP in chronic obstructive pulmonary disease patients. An Sist Sanit Navar 2009; 32(2): 235-41.
7. de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ et al. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol 2010; 55(8): 725-31.
8. Kitabatake A, Inoue M, Asao M, Masuyama T, Tanouchi J, Morita T et al. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation 1983; 68: 302-309.
9. Devereux RB, Savage DD, Sachs I, Laragh JH. Relation of hemodynamic load to left ventricular hypertrophy and performance in hypertension. Am J Cardiol 1983; 51: 171-176.
Int J Biomed. 2011; 1(2):71-73.© 2011 International Medical Research and Development Corporation. All rights reserved.