Elsevier

American Heart Journal

Volume 156, Issue 3, September 2008, Pages 506-512
American Heart Journal

Clinical Investigation
Imaging and Diagnostic Testing
Cardiovascular magnetic resonance imaging to identify left-sided chronic heart failure in stable patients with chronic obstructive pulmonary disease

https://doi.org/10.1016/j.ahj.2008.04.021Get rights and content

Background

Although cardiovascular magnetic resonance imaging (CMR) is well established, its diagnostic accuracy in identifying chronic heart failure (CHF) in patients with chronic obstructive pulmonary disease (COPD) has not yet been quantified.

Methods

Participants were recruited from a cohort of 405 patients aged ≥65 years, with mild to moderate and stable COPD. In this population, 83 (20.5%) patients had a new diagnosis of CHF, all left-sided, established by an expert panel using all available diagnostic information, including echocardiography. In a nested case-control study design, 37 consecutive COPD patients with newly detected CHF (cases) and a random sample of 41 of the remaining COPD patients (controls) received additional CMR measurements. The value of CMR in diagnosing heart failure was quantified using univariable and multivariable logistic modeling in combination with area under the receiver operating characteristic curves (ROC-area).

Results

Combination of CMR measurements of left ventricular ejection fraction, indexed left and right atrial volume, and left ventricular end-systolic dimensions provided high added diagnostic value beyond clinical items (ROC-area 0.91) for identifying CHF. Left-sided measurements of CMR and echocardiography correlated well, including ejection fraction. Right ventricular mass divided by right ventricular end-diastolic volume was higher in COPD patients with CHF than in those without concomitant CHF.

Conclusions

Easily assessable morphologic and volume-based CMR measurements have excellent capacities to identify previously unknown left-sided chronic heart failure in mild to moderate COPD patients. There seems to be an adaptive tendency to concentric right ventricular hypertrophy in COPD patients with left-sided CHF.

Section snippets

Study population

Participants were recruited from a cohort of 405 patients aged ≥65 years, with a general practitioner's diagnosis of COPD and in a stable phase of their disease. Patients known with CHF were excluded from participation in this study. All 405 participants underwent an extensive diagnostic workup, including medical history and physical examination, blood tests, chest radiography, electrocardiography (ECG), echocardiography, and pulmonary function tests. Detailed information about the diagnostic

Results

Baseline demographics and clinical characteristics of COPD patients with or without CHF are presented in Table I. Most participants had mild to moderate COPD according to the pulmonary function tests results. The number of patients with severely decreased LVEF was small; only 5 participants had a LVEF <30% with echocardiography. In 25 (67.6%) of the 37 patients with CHF, the panel considered ischemic heart disease as the suspected etiology, including 15 patients with a history of ischemic heart

Discussion

Our study is the first to quantify the diagnostic value of easily assessable CMR measurements in identifying unsuspected left-sided chronic heart failure in stable mild to moderate COPD patients. A CMR model including measurements of LVEF, indexed left and right atrial volume, and LV end-systolic dimensions had a ROC-area of 0.88 for determining presence or absence of CHF, with the consensus diagnosis of an experienced panel as the reference standard. When added to a model with signs and

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    Research grant number 904-61-144 of the Netherlands Organization for Scientific Research. Roche (Mannheim, Germany) supplied the NT-proBNP assays.

    All authors declare that they have no competing interest.

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