Clinical Overview of Chronic Obstructive Pulmonary Disease Patients with Myocardial Perfusion Defect

Abstract

Abstract: Background: Increased hospitalization and death rates up to 2-3 times greater due to cardiovascular diseases have been reported in Chronic Obstructive Pulmonary Disease (COPD) cases. Inflammation, neurohumoral activation, and increased oxidative stress are involved in the etiopathogenesis of both disease groups. Objective: The study aimed to retrospectively evaluate the patients with COPD with perfusion defects (ischemia/infarct) in myocardial perfusion scintigraphy and investigate the clinical features of these patients. Materials and Methods: Patients with COPD were included in the study by examining the files of 196 patients who had perfusion defects by performing myocardial perfusion scintigraphy (MPS) in the Nuclear Medicine Clinic of our hospital between January 2019-2021. Demographic data, comorbidities, areas of involvement in myocardial perfusion scintigraphy, pulmonary function test (PFT), smoking history, modified Medical Research Council (mMRC) score, pulse oxygen saturation, and echocardiography (ECHO) data were recorded. Results: COPD was detected in 6 (3%) of 196 patients. All of these cases were male and the age range was 67.2 ± 7.4 years. All 6 cases were male, and the mean age was 67.2 ± 7.4 years. They all had a history of heavy smoking (52.5 ± 30.9 packs/year). The mean forced expiratory volume in 1 second (FEV1) was 49.6 ± 8.9%, and pulse oxygen saturation was 93.2 ± 3.3%. In ECHO, systolic pulmonary artery pressure (PAPs) was higher than normal in 2 patients; one had advanced mitral insufficiency and heart failure. In the MPS of 4 patients, an infarct was observed in the area supplied by the right coronary artery (RCA). While there was no comorbid disease in 2 patients, comorbid diseases were present in 4. There was no significant difference between the non-COPD group and the COPD group in terms of age and gender. In the non-COPD group, the most common LAD localized defect (35.3%) and RCA localized defect (23.2%) were detected, while the most common RCA defect (50%) was found in the COPD group. However, it was not statistically significant due to the small sample size. Conclusion: In COPD cases, it was determined that infarct developed in the male gender, advanced age and advanced stage, and especially in the area fed with RCA if exposed to heavy smoking. It is considered that the ischemic changes observed in RCA in COPD may have a role in the development of right heart failure.