Skip to main content

Subclinical cardiovascular changes in chronic obstructive pulmonary disease patients: Doppler ultrasound evaluation

Abstract

Introduction

Chronic obstructive pulmonary disease (COPD) is a disease characterized by progressive poorly reversible airway obstruction. COPD is associated with chronic systemic inflammation, hypercoagulable status, platelet activation, and oxidative stress. These factors may result in subclinical cardiovascular diseases (CVD): for example, carotid atherosclerosis, peripheral arterial diseases, and coronary artery diseases.

Aims

The aim of this case–control study was the detection of subclinical CVD in COPD patients.

Settings and design

This was a case–control study.

Materials and methods

A total of 62 COPD patients and 62 healthy volunteers were enrolled in the present study. All patients were subjected to full medical history and clinical examination, chest radiography, arterial blood gas analysis, laboratory assessment of C-reactive protein, complete blood count, lipid profile, spirometry, transthoracic echocardiography, carotid Doppler ultrasound, and measurement of ankle-brachial index. A comparison between COPD and control groups regarding different parameters was performed, and a comparison between different stages of COPD regarding different parameters was also performed.

Results

The carotid intima-media thickness and carotid plaques were significantly higher, whereas the ankle-brachial index was significantly lower in COPD patients compared with the control group, with no differences observed in different stages of COPD. Pulmonary hypertension and right ventricular dilatation were significantly common in COPD patients compared with the control group, and they were significantly increased with progressive stages of COPD. Pulmonary artery systolic pressure and carotid intima-media thickness showed a significant negative correlation with PaO2, but showed a significant positive correlation with PaCO2.

Conclusion

COPD is a risk factor for subclinical CVD, mainly carotid artery atherosclerosis and peripheral arterial diseases.

References

  1. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187:347–365.

    Article  CAS  Google Scholar 

  2. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349:1436–1442.

    Article  CAS  Google Scholar 

  3. Vestbo J, Hurd SS, Rodriguez-Roisin R. The 2011 revision of the global strategy for the diagnosis, management and prevention of COPD (GOLD)–why and what? Clin Respir J 2012; 6:208–214.

    Article  Google Scholar 

  4. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest 2007; 131:1557–1566.

    Article  CAS  Google Scholar 

  5. Stone IS, Barnes NC, Petersen SE. Chronic obstructive pulmonary disease: a modifiable risk factor for cardiovascular disease? Heart 2012; 98:1055–1062.

    Article  Google Scholar 

  6. Maclay JD, MacNee W. Cardiovascular diseases in COPD. Chest 2013; 143:798–807.

    Article  CAS  Google Scholar 

  7. Curci JA, Liao S, Huffman MD, Shapiro SD, Thompson RW. Expression and localization of macrophage elastase (matrix metalloproteinase-12) in abdominal aortic aneurysms. J Clin Invest 1998; 102:1900–1910.

    Article  CAS  Google Scholar 

  8. Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002; 20:159–169.

    Article  CAS  Google Scholar 

  9. Kim ES, Wattanakit K, Gornik HL. Using the ankle-brachial index to diagnose peripheral artery disease and assess cardiovascular risk. Cleve Clin J Med 2012; 79:651–661.

    Article  Google Scholar 

  10. Ozgen Alpaydin A, Konyar Arslan I, Serter S, Sakar Coskun A, Celik P, Taneli F, Yorgancioglu A. Metabolic syndrome and carotid intima-media thickness in chronic obstructive pulmonary disease. Multidiscip Respir Med 2013; 8:61.

    Article  Google Scholar 

  11. Maclay JD, McAllister DA, Macnee W. Cardiovascular risk in chronic obstructive pulmonary disease. Respirology 2007; 12:634–641.

    Article  Google Scholar 

  12. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 2005; 127:1952–1959.

    Article  Google Scholar 

  13. Sin DD, Man SF. 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 2003; 107:1514–1519.

    PubMed  Google Scholar 

  14. Gan WQ, Man SF, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax 2004; 59:574–580.

    Article  CAS  Google Scholar 

  15. Kim SJ, Yoon DW, Lee EJ, Hur GY, Jung KH, Lee SY, et al. Carotid atherosclerosis in patients with untreated chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2011; 15:1265–1270.

    Article  CAS  Google Scholar 

  16. Pobeha P, Skyba P, Joppa P, Kluchova Z, Szaboova E, Tkac I, Tkacova R. Carotid intima-media thickness in patients with chronic obstructive pulmonary disease. Bratisl Lek Listy 2011; 112:24–28.

    CAS  PubMed  Google Scholar 

  17. Barr RG, Ahmed FS, Carr JJ, Hoffman EA, Jiang R, Kawut SM, Watson K. Subclinical atherosclerosis, airflow obstruction and emphysema: the MESA Lung Study. Eur Respir J 2012; 39:846–854.

    Article  CAS  Google Scholar 

  18. Pecci R, de La Fuente Aguado J, Sanjurjo Rivo AB, Sanchez Conde P, Corbacho Abelaira M. Peripheral arterial disease in patients with chronic obstructive pulmonary disease. Int Angiol 2012; 31:444–453.

    CAS  PubMed  Google Scholar 

  19. Matsuoka H, Matsumoto Y, Kimura K, et al. Leg atherosclerosis in Japanese COPD patients: prevalence of undiagnosed peripheral artery disease and association between leg atherosclerosis and clinical indices. Open J Resp Dis 2013; 3:25–30.

    Google Scholar 

  20. Freixa X, Portillo K, Pare C, Garcia-Aymerich J, Gomez FP, Benet M, et al. PAC-COPD Study Investigators Echocardiographic abnormalities in patients with COPD at their first hospital admission. Eur Respir J 2013; 41:784–791.

    Article  Google Scholar 

  21. Gupta NK, Agrawal RK, Srivastav AB, Ved ML. Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease. Lung India 2011; 28:105–109.

    Article  CAS  Google Scholar 

  22. Sultan KM, Hussain MF, Ismael AA. The relation of echocardiographic findings to pulmonary function tests in patients with chronic obstructive pulmonary disease. J Fac Med Baghdad. 2009; 51:25–35.

    Google Scholar 

  23. Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE. Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest 2005; 127:1898–1903.

    Article  Google Scholar 

  24. Yilmaz R, Gencer M, Ceylan E, Demirbag R. Impact of chronic obstructive pulmonary disease with pulmonary hypertension on both left ventricular systolic and diastolic performance. J Am Soc Echocardiogr 2005; 18:873–881.

    Article  Google Scholar 

  25. Mapel DW, Dedrick D, Davis K. Trends and cardiovascular co-morbidities of COPD patients in the Veterans Administration Medical System, 1991–1999. COPD 2005; 2:35–41.

    Article  Google Scholar 

  26. Agusti A, Soriano JB. COPD as a systemic disease. COPD 2008; 5:133–138.

    Article  Google Scholar 

  27. Chhabra SK. Pulmonary hypertension associated with chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2010; 52:29–40.

    PubMed  Google Scholar 

  28. Rodriguez-Roisin R, MacNee W. Pathophysiology of chronic obstructive pulmonary disease. Eur Respir Mon 2006; 38:177–200.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Samiaa H. Sadek MD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sadek, S.H., Hassan, A.A., AbdElrahman, G. et al. Subclinical cardiovascular changes in chronic obstructive pulmonary disease patients: Doppler ultrasound evaluation. Egypt J Bronchol 9, 140–145 (2015). https://doi.org/10.4103/1687-8426.158046

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.158046

Keywords

  • arterial blood gases
  • carotid atherosclerosis
  • chronic obstructive pulmonary disease
  • peripheral arterial diseases