Comorbidity of chronic heart failure and chronic obstructive pulmonary disease: features of pathogenesis, clinic and diagnostics

This article discusses the epidemiology of chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). CHF and COPD are characterized by high prevalence and high mortality, especially when they are combined. The article analyzes the general mechanisms of formation of these diseases: the relationship of COPD with cardiovascular diseases is explained by common risk factors, including smoking, physical inactivity, improper feeding and genetic predisposition. The leading role in the pathogenesis of pathologies is played by the activation and maintenance of systemic inflammation. Article presents the features of the clinical picture and the direction of the diagnostics in case of suspected combined pathology, the possibilities of modern laboratory and instrumental research methods. Diagnostics of comorbidity of CHF and COPD may be difficult, given the above common risk factors, some common pathogenesis mechanisms and similar clinical symptoms. However the caution regarding the comorbidity of the studied conditions, as well as a thorough clinical examination and the appointment of the necessary additional research methods, can reduce the number of diagnostic mistakes and improve the prognosis in such patients.

1. Mareev V, Fomin I, Ageev F, et al. Clinical Guidelines. Chronic Heart Failure (CHF). Serdechnaja Nedostatochnost'. 2017;18(1):3-40. (In Russ.) doi:1018087/rhfj.20171.2346.

2. Roger V, Go A, Lloyd-Jones D, et al. Executive Summary: Heart Disease and Stroke Statistics-2012 Update: A Report From the American Heart Association. Circulation. 2012;125(1):188-97 doi:10.1161/cir.0b013e3182456d46.

3. Maggioni A, Dahlstrom U, Filippatos G, et al. EURObservationalResearch Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013;15(7):808-17 doi:10.1093/eurjhf/hft050.

4. Flu W, van Gestel Y, van Kuijk J, et al. Co-existence of COPD and left ventricular dysfunction in vascular surgery patients. Respir Med. 2010;104(5):690-6. doi:10.1016/j.rmed.2009.11.013.

5. Cazzola M, Bettoncelli G, Sessa E, et al. Prevalence of Comorbidities in Patients with Chronic Obstructive Pulmonary Disease. Respiration. 2010;80(2):112-9. doi:10.1159/000281880.

6. Hawkins N, Wang D, Petrie M, et al. Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme. Eur J Heart Fail. 2010;12(6):557-65. doi:101093/eurjhf/hfq040.

7. Lamprecht B. COPD bei Nichtrauchern — Ergebnisse der Salzburger “Burden of Obstructive Lung Disease (BOLD)”-Studie. Atemwegs- und Lungenkrankheiten. 2011;37(02):45-7 doi:10.5414/atp37045German.

8. Sin D. Chronic Obstructive Pulmonary Disease as a Risk Factor for Cardiovascular Morbidity and Mortality. Proc Am Thorac Soc. 2005;2( 1 ):8-11. doi: 10.1513/pats.200404-032ms.

9. McGarvey L, John M, Anderson J, et al. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax. 2007;62(5):411-5. doi:10.1136/thx.2006.072348.

10. Buist A, McBurnie M, Vollmer W, et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. The Lancet. 2007;370(9589):741-50. doi:10.1016/s0140-6736(07)61377-4.

11. Pope C, Burnett R, Turner M, et al. Lung Cancer and Cardiovascular Disease Mortality Associated with Ambient Air Pollution and Cigarette Smoke: Shape of the Exposure-Response Relationships. Environ Health Perspect. 2011;119(11):1616-21. doi:10.1289/ehp.1103639.

12. Singh D. Small Airway Disease in Patients with Chronic Obstructive Pulmonary Disease. Tuberc Respir Dis (Seoul). 2017;80(4):317 doi:10.4046/trd.20170080.

13. Fernandez-Ruiz I. Air pollution accelerates progression of atherosclerosis. Nature Reviews Cardiology. 2016;13(7):379. doi:10.1038/nrcardio.2016.97.

14. Rajan A, Joshi A, Hajyzadegan E. Effect of Cigarette Smoking on Leukocytes Count in Human Adult Males. Internat J of Physiol. 2014;2(1):107 doi: 10.5958/j.2320-608x.2.1.023.

15. Ding J, Teng G. Molecular Imaging of Matrix Metalloproteinases in Vulnerable Plaque in Atherosclerosis. Acta Biophysica Sinica. 2011;27(4):312-3. doi:10.3724/sp.j.1260.2011.00312.

16. Golikova I. MS180 system inflammation markers and markers of endothelial function in patients with coronary artery disease (unstable and stable angina). Atherosclerosis Supplements. 2010;11(2):146. doi:10.1016/s1567-5688(10)70681-4.

17. Van Eeden S, Leipsic J, Paul Man S, et al. The Relationship between Lung Inflammation and Cardiovascular Disease. Am J Respir Crit Care Med. 2012;186(1):11-6. doi:10.1164/rccm.201203-0455pp.

18. Berger J. Risk of Myocardial Infarction and Stroke After Acute Infection or Vaccination. Yearbook of Neurology and Neurosurgery. 2006;2006:190-1. doi: 10.1016/s0513-5117(08)70363-6.

19. Patel A, Kowlessar B, Donaldson G, et al. Cardiovascular risk, myocardial injury, and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;188(9):1091-9. doi:10.1164/rccm.201306-1170OC.

20. Donaldson G, Hurst J, Smith C, et al. Increased Risk of Myocardial Infarction and Stroke Following Exacerbation of COPD. Chest. 2010;137(5): 1091-7. doi:101378/chest.09-2029.

21. Cassee F, Mills N, Newby D. Cardiovascular Effects Of Inhaled Ultrafine And Nanosized Particles. Hoboken N. J.: John Wiley; 2011. 585 p. ISBN: 978-0-47043353-9.

22. Maurer J. Regular Physical Activity Modifies Smoking-related Lung Function Decline and Reduces Risk of Chronic Obstructive Pulmonary Disease: A Population-based Cohort Study. Yearbook of Pulmonary Disease. 2008;2008:76-7. doi:101016/s8756-3452(08)70575-9

23. Davis T. Lung function, diabetes and the metabolic syndrome. Practical Diabetes. 2014;31(5):184-5. doi:10.1002/pdi.1861.

24. Taranto-Montemurro L, Messineo L, Perger E et al. Cardiac Sympathetic Hyperactivity in Patients with Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea. COPD: J Chronic Obstruct Pulmon Dis. 2016;13(6):706-11. doi:10.1080/15412555.20161199668.

25. Fabbri L, Beghe B, Agusti A. Cardiovascular mechanisms of death in severe COPD exacerbation: time to think and act beyond guidelines. Thorax. 2011;66(9):745-7. doi:10.1136/thoraxjnl-2011-200406.

26. Ponikowski P, Voors A, Anker S et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-200. doi:10.1093/eurheartj/ehw128.

27. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available at: http://goldcopd.org.8 March 2018.

28. Olesen L, Andersen A. ECG as a first step in the detection of left ventricular systolic dysfunction in the elderly. ESC Heart Fail. 2015;3(1):44-52. doi:10.1002/ehf2.12067.

29. Triposkiadis F, Giamouzis G, Boudoulas K, et al. Left ventricular geometry as a major determinant of left ventricular ejection fraction: physiological considerations and clinical implications. Eur J Heart Fail. 2018;20(3):436-44. doi:10.1002/ejhf.1055.

30. Kasner M, Sinning D, Lober J, et al. Heterogeneous responses of systolic and diastolic left ventricular function to exercise in patients with heart failure and preserved ejection fraction. ESC Heart Fail. 2015;2(3):121-32. doi:10.1002/ehf2.12049.

31. Huang G, Xu J, Zhang T. Is Left Ventricular Ejection Fraction by Echo in Patients With Atrial Fibrillation Reliable? JACC: Heart Failure. 2017;5(6):468-9. doi:10.1016/j.jchf.2017.02.014.

32. Carluccio E, Dini F, Biagioli P, et al. The “Echo Heart Failure Score”: an echocardiographic risk prediction score of mortality in systolic heart failure. Eur J Heart Fail. 2013;15(8):868-76. doi:10.1093/eurjhf/hft038.

33. A Critical Review of the Ability of Continuous Cardiac Output Monitors to Measure Trends in Cardiac Output. Survey of Anesthesiology. 2011;55(5):253. doi:101097/01.sa.0000400023.65937.be.

34. Arques S. Clinical relevance of spectral tissue Doppler-derived E/e' in the diagnosis of heart failure with preserved ejection fraction. Eur J Heart Fail. 2017. [Epub ahead of print]. doi:10.1002/ejhf.1084.

35. Schwitter J, Arai A. Assessment of cardiac ischaemia and viability: role of cardiovascular magnetic resonance. Eur Heart J. 2011;32(7):799-809. doi:10.1093/eurheartj/ehq481.

36. Balkissoon R. The Journal Club: Computed Tomography and COPD. Chronic Obstructive Pulmonary Diseases. J COPD Foundation. 2017;4(4):325-30. doi:10.15326/jcopdf.4.4.2017.0174.

37. Hawkins N, Petrie M, Jhund P, et al. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009;11(2):130-9. doi:10.1093/eurjhf/hfn013.

38. Asanov T, Gasimova S, Grishina K, et al. Evaluation of static and dinamic volumes measered by body plethysmography in patients with chronic obstructive pulmonary disease. Smolenskij medicinskij al'manah. 2016;1:21-3. (In Russ.).

39. Statsenko ME, Ivanova DA, Sporova OE, et al. Clinical peculiarities, life quality and cardio-renal relationships in patients with chronic heart failure and chronic obstructive pulmonary disease. Volgogradskij nauchno-medicinskij zhurnal. 2012;4(36):22-7. (In Russ.)

40. Cattadori G, Agostoni P, Corra U, et al. Heart failure and anemia: Effects on prognostic variables. Eur J Intern Med. 2017;37:56-63. doi:101016/j.ejim.2016.09.011.

41. Omar H, Guglin M. Extremely elevated BNP in acute heart failure: Patient characteristics and outcomes. Int J Cardiol. 2016;218:120-5. doi: 10.1016/j.ijcard.2016.05.038.

42. Daniels L, Maisel A. Natriuretic peptides. JACC. 2007;50(25):2357-68. doi:101016/j.jacc.2007.09.021.

43. Maisel A, Mueller C. European-North American B-Type Natriuretic Peptide (BNP) Consensus Working Group. Congestive Heart Failure. 2008;14:4-4. doi:10.1111/j.1751-7133.2008.tb00001.x.

44. Baimakanova G, Avdeev S. Diagnostic and prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute exacerbations of COPD. Pul'monologiya. 2011;6:80-6. (In Russ.)

45. Chang C, Robinson S, Mills G, et al. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax. 2011;66(9):764-8. doi:10.1136/thx.2010.155333.