Abstract
BackgroundIschemic heart disease is common in COPD and associated with worse prognosis. This study aimed to investigate the presence and prognostic impact of biomarkers of myocardial injury and ischemia among individuals with COPD and normal lung function, respectively.MethodsIn 2002–04, all individuals with airway obstruction (FEV1/VC < 0.70, n = 993) were identified from population-based cohorts, together with age and sex-matched non-obstructive referents. At re-examination in 2005, spirometry, Minnesota-coded ECG and analyses of high-sensitivity cardiac troponin I (hs-cTnI) were performed in individuals with COPD (n = 601) and those with normal lung function (n = 755). Deaths were recorded until December 31st, 2010.ResultsHs-cTnI concentrations were above the risk stratification threshold of ≥5 ng/L in 31.1 and 24.9% of those with COPD and normal lung function, respectively. Ischemic ECG abnormalities were present in 14.8 and 13.4%, while 7.7 and 6.6% had both elevated hs-cTnI concentrations and ischemic ECG abnormalities. The 5-year cumulative mortality was higher in those with COPD than those with normal lung function (13.6% vs. 7.7%, p < 0.001). Among individuals with COPD, elevated hs-cTnI both independently and in combination with ischemic ECG abnormalities were associated with an increased risk for death (adjusted hazard ratio [HR]; 95% confidence interval [CI] 2.72; 1.46–5.07 and 4.54; 2.25–9.13, respectively). Similar associations were observed also among individuals with COPD without reported ischemic heart disease.ConclusionsIn this study, elevated hs-cTnI concentrations in combination with myocardial ischemia on the electrocardiogram were associated with a more than four-fold increased risk for death in a population-based COPD-cohort, independent of disease severity.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is a common but under-diagnosed disease [1, 2]
Increased troponin levels are associated with poor prognosis in patients with acute exacerbations of COPD [14, 15]
Among those with COPD, 41.6, 51.1 and 7.3% were classified as GOLD grades 1, 2 and 3–4 respectively
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a common but under-diagnosed disease [1, 2]. High-sensitivity cardiac troponin I (hs-cTnI) assays have limits of detection 10 to 100-fold lower than contemporary assays and can detect troponin in the majority of healthy individuals [9] These assays may identify patients with subclinical cardiac disease [10], using risk stratification thresholds well below those used to diagnose myocardial infarction [11, 12]. One recent study, including stable patients with mainly moderate and severe COPD, showed a correlation between hs-cTnI ≥6 ng/L and poor prognosis [16] This has rarely been evaluated in population-based COPD-studies. We hypothesise that hs-cTnI concentrations reflect subclinical heart disease and may help to guide prognosis among individuals with COPD in the population If this hypothesis is confirmed, hs-cTnI testing could be used more widely to identify individuals with COPD at increased risk
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