- Original article
- Open Access
Subclinical cardiovascular changes in chronic obstructive pulmonary disease patients: Doppler ultrasound evaluation
Egyptian Journal of Bronchology volume 9, pages 140–145 (2015)
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.
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.
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.
COPD is a risk factor for subclinical CVD, mainly carotid artery atherosclerosis and peripheral arterial diseases.
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.
Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349:1436–1442.
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.
Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest 2007; 131:1557–1566.
Stone IS, Barnes NC, Petersen SE. Chronic obstructive pulmonary disease: a modifiable risk factor for cardiovascular disease? Heart 2012; 98:1055–1062.
Maclay JD, MacNee W. Cardiovascular diseases in COPD. Chest 2013; 143:798–807.
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.
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.
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.
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.
Maclay JD, McAllister DA, Macnee W. Cardiovascular risk in chronic obstructive pulmonary disease. Respirology 2007; 12:634–641.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Agusti A, Soriano JB. COPD as a systemic disease. COPD 2008; 5:133–138.
Chhabra SK. Pulmonary hypertension associated with chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2010; 52:29–40.
Rodriguez-Roisin R, MacNee W. Pathophysiology of chronic obstructive pulmonary disease. Eur Respir Mon 2006; 38:177–200.
About this article
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
- arterial blood gases
- carotid atherosclerosis
- chronic obstructive pulmonary disease
- peripheral arterial diseases