Abstract
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) may coexist in elderly patients with a history of smoking. Low-grade systemic inflammation induced by smoking may represent the link between these 2 conditions. In this study, we investigated left ventricular dysfunction in patients primarily diagnosed with COPD, and nonreversible airflow limitation in patients primarily diagnosed with CHF. The levels of circulating high-sensitive C-reactive protein (Hs-CRP), pentraxin 3 (PTX3), interleukin-1β (IL-1 β), and soluble type II receptor of IL-1 (sIL-1RII) were also measured as markers of systemic inflammation in these 2 cohorts. Patients aged ≥50 years and with ≥10 pack years of cigarette smoking who presented with a diagnosis of stable COPD (n=70) or stable CHF (n=124) were recruited. All patients underwent echocardiography, N-terminal pro-hormone of brain natriuretic peptide measurements, and post-bronchodilator spirometry. Plasma levels of Hs-CRP, PTX3, IL-1 β, and sIL-1RII were determined by using a sandwich enzyme-linked immuno-sorbent assay in all patients and in 24 healthy smokers (control subjects). Although we were unable to find a single COPD patient with left ventricular dysfunction, we found nonreversible airflow limitation in 34% of patients with CHF. On the other hand, COPD patients had higher plasma levels of Hs-CRP, IL1 β, and sIL-1RII compared with CHF patients and control subjects (p < 0.05). None of the inflammatory biomarkers was different between CHF patients and control subjects. In conclusion, although the COPD patients had no evidence of CHF, up to one third of patients with CHF had airflow limitation, suggesting that routine spirometry is warranted in patients with CHF, whereas echocardiography is not required in well characterized patients with COPD. Only smokers with COPD seem to have evidence of systemic inflammation.
Highlights
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are important causes of morbidity and mortality worldwide, in the elderly [1,2]
Of the CHF patients, 86% were classified as New York Heart Association (NYHA) class I or II, and 63% of COPD patients were classified as GOLD stage I or II (Table 1)
Patients with pure COPD had a higher 6min walk test (6MWT), a lower Charlson comorbidity index, a lower NT-proBNP, and a higher high-sensitive Creactive protein (Hs-C-reactive protein (CRP)) compared with all the CHF patients (Table 2)
Summary
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are important causes of morbidity and mortality worldwide, in the elderly [1,2]. Cigarette smoking is the major risk factor for COPD and cardiovascular diseases It causes systemic inflammation, oxidative stress, increased circulating concentration of inflammatory cytokines, and changes in endothelial functions. C-reactive protein (CRP) is the most established marker of systemic inflammation, plays an important role in COPD [5], and is involved, to a lesser extent, in CHF [6]. Another acute phase inflammatory protein of the pentraxin family (PTX3) has been proved to be linked to the severity and prognosis of CHF [7]. Since the decoy receptor sIL-1RII plays a key role in downing the action of IL-1 β [8], its plasma level has been determined
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