Cardiac structure and function at baseline in the DEFLATA study: The impact of lung hyperinflation and its relationship with the GOLD classification

INTRODUCTION The mechanisms underlying cardiac dysfunction and its impact on symptoms in COPD are poorly understood. AIMS 1) To compare cardiac structure and function in COPD of varying severities; 2) To establish the impact of lung hyperinflation on cardiac structure and function; 3) To identify determinants of respiratory symptoms in this cohort METHODS Between December 2012-2013, 30 hyperinflated COPD patients were randomized into the DEFLATA study and underwent cardiac magnetic resonance, spirometry, body plethysmography, arterial stiffness and baseline bloods. RESULTS Smaller ventricular volumes were found in GOLD stage 4 vs GOLD 1-3 (right ventricle end diastolic volume Index 61±18 vs 85±15 ml (p=0.003), left ventricle end diastolic volume index 52±16 vs 70±8 ml p=0.001). No differences in cardiac structure were found when separated according to the ABCD classification. Although no relationship was found between lung hyperinflation and ventricular size, residual volume percent predicted (Rvol) was related to reduced left atrial size independent of gender, oxygen saturations (SO2), central systolic pressure, LV ejection and fibrinogen (β=-0.13, p=0.028). Fibrinogen related to COPD Assessment Test (CAT) scores independent of age, spirometry, Rvol, SO2, exacerbations, and cardiac function (β=7.9, p=0.03). CONCLUSION Air flow limitation and lung hyperinflation are associated with reduced cardiac chamber size, although this has no independent impact on respiratory symptoms, where it appears systemic inflammation may have a role. Further studies are warranted to establish whether these cardiac morphological changes are reversible.