FACT – A NEW PREDICTION SCORE FOR SUPRAVENTRICULAR TACHYARRHYTHMIAS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Abstract

Objective: Chronic obstructive pulmonary disease (COPD) patients have an increased risk of atrial arrhythmias, with a significant impact on prognosis. Our aim was to determine a prediction score for developing supraventricular arrhythmias (SVT) in COPD patients, for an adequate selection of those who would benefit from Holter monitoring for early diagnosis of SVT. Design and method: COPD patients admitted to our clinic were included in this study, after excluding those with heart failure, decreased systolic function, ischemic heart disease, hemodynamically significant valvular disease, pulmonary embolism, permanent rhythm or conduction abnormalities, antiarrhythmic treatment or pacing/resynchronization therapy. SVT were defined as presence of atrial fibrillation, atrial flutter or atrial tachycardias. The FA2CT score was composed of forced expiratory volume in the first second (FEV1), right atrium diameter (RA), arterial pressure of carbon dioxide (pCO2) and the presence of arterial hypertension (HTN). Results: Of the 43 patients with a mean age of 65.1 ± 9.3 years, 65.1% men, 60.5% presented SVT. In multivariate analysis, FEV1 (p = 0.053), RA (p = 0.028) and pCO2 (p = 0.037) were independent predictors of SVT. In ROC curve analysis, the prediction model FEV1+AD had an AUC of 0.545 (95%CI 0.358–0.733, p = ns), FEV1+AD+pCO2 – AUC 0.713 (95%CI 0.542–0.883, p = 0.020), and the FA2CT prediction model (FEV1+AD+pCO2+HTA) – AUC 0.799 (95%CI 0.663–0.935, p = 0.001). The FA2CT score was derived from the prediction model: FEV1 < 1000 ml (1 point), RA > 35 mm (2 points), pCO2 > 45mmHg (1 point) and presence of HTN (1 point). Scores ranged from 0 to 5, with SVT in 25% of patients with score 0, 40% - score 1, 60% - score 2, 63.63% - score 3, 78.57% - score 4 and 50% - score 5, p for trend = 0.084. The predictive value of the FA2CT model was significantly amplified by adding the presence and number of atrial extrasystoles /24 hours on Holter monitoring (AUC 0.889 (95%CI 0.782–0.986, p < 0.001). Conclusions: Based on routine clinical, imaging and functional tests for patients with COPD, the FA2CT score could be useful in identifying those at high risk of developing supraventricular tachyarrythmias. Patients with an elevated score could benefit from Holter monitoring to diagnose SVT and establish the adequate therapeutic conduct.