Cardiac autonomic neuropathy: The hidden cardiovascular comorbidity in elderly patients with chronic obstructive pulmonary disease attending primary care settings

Rasheedy, Doha; Taha, Hend M.

doi:10.1111/ggi.12473

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…Rasheedy et al examined elderly outpatients with COPD and measured heart-rate and blood-pressure response to different stimuli. It was found that among patients with cardiac autonomic dysfunction, a higher baseline heart rate and higher CO 2 levels represented severity of the disease 36. The data from our study revealed higher bicarbonate levels in the prolonged-QTc group, which might represent the chronic compensation of CO 2 retention found in severe COPD patients.…”

Section: Discussionsupporting

confidence: 48%

<p>Long QT and death in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease is not related to electrolyte disorders</p>

Zilberman-Itskovich¹,

Rahamim²,

Tsiporin-Havatinsky³

et al. 2019

COPD

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Objectives: COPD is the fourth-leading cause of mortality worldwide. Prolonged QTc has been found to be a long-term negative prognostic factor in ambulatory COPD patients. The aim of this study was to evaluate the extent of prolonged-QTc syndrome in COPD patients upon admission to an internal medicine department, its relationship to hypomagnesemia, hypokalemia, and hypocalcemia, and the effect of COPD treatment on mortality during hospital stay. Methods: This prospective cohort study evaluated COPD patients hospitalized in an internal medicine department. The study evaluated QTc, electrolyte levels, and known risk factors during hospitalization of COPD patients. Results: A total of 67 patients were recruited. The median QTc interval was 0.441 seconds and 0.434 seconds on days 0 and 3, respectively. Prolonged QTc was noted in 35.8% of patients on admission and 37.3% on day 3 of hospitalization. The median QTc in the prolonged-QTc group on admission was 0.471 seconds and in the normal-QTc group 0.430 seconds. There was no significant difference in age, sex, electrolyte levels, renal function tests, or blood gases on admission between the two groups. Mortality during the hospital stay was significantly higher in the prolonged-QTc group (3 deaths, 12%) than in the normal QTc group (no deaths) ( P =0.04). A subanalysis was performed, removing known causes for prolonged QTc. We found no differences in age, electrolytes, or renal functions. There was a small but significant difference in bicarbonate levels. Conclusion: Our findings demonstrated that there was no correlation between QTc prolongation in hospitalized COPD patients and electrolyte levels, comorbidities, or relevant medications. A higher rate of mortality was noted in patients with prolonged QTc in comparison to normal QTc. As such, it is suggested that prolonged QTc could serve as a negative prognostic factor for mortality during hospitalization in COPD patients.

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Section: Discussionsupporting

confidence: 48%

<p>Long QT and death in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease is not related to electrolyte disorders</p>

Zilberman-Itskovich¹,

Rahamim²,

Tsiporin-Havatinsky³

et al. 2019

COPD

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“…Therefore, it was considered as a probable pathogenetic mechanism behind increased mortality in patients with diabetes mellitus. CAN-related morbidity and mortality have also been researched in other diseases, including familial dysautonomia [ 15 ], Ehlers-Danlos syndrome [ 16 ], chronic obstructive pulmonary disease [ 17 ], liver cirrhosis [ 18 ], hypertension and hyperuricemia [ 19 ]. Furthermore, it was shown to predict all-cause mortality and sudden death in patients with chronic heart failure following ischemic or idiopathic dilated cardiomyopathy [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Autonomic Neuropathy and its Association with Cardiovascular and All-cause Mortality in Patients with End-stage Renal Disease

Bokhari

Inayat

Jawa

et al. 2018

Cureus

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BackgroundEnd-stage renal disease frequently leads to increased cardiovascular mortality. Cardiovascular autonomic neuropathy (CAN) may be predictive of cardiac arrhythmias and sudden cardiac death in patients with end-stage renal disease.MethodsA total of 70 patients with end-stage renal disease were included in the study. The assessment of cardiac dysautonomia was based on the four standardized tests performed at the baseline and, again, at the end of the study. The criteria for CAN included at least two abnormal test results.ResultsFifty of 70 patients completed the study and were followed-up after one year. Out of the 50 patients, 44 (88%) had CAN at baseline. Twelve (24%) patients died at the one-year follow-up. Sudden cardiac death was reported in seven out of 12 (58%) patients. All seven patients who died had high dysautonomia scores (three abnormal tests) at the baseline. There was a significantly higher percentage of patients with all four abnormal tests amongst patients who died of any cause (56% vs. 17%; RR 6.07, 95% CI 1.29-28.49; p-value 0.02) or due to sudden cardiac death (43% vs. 10.5%; RR 6.37, 95% CI 1.03-39.36; p-value 0.04). All five patients who did not have CAN at the baseline developed this abnormality on repeat testing after one year.ConclusionThe prevalence of CAN in patients with end-stage renal disease on maintenance hemodialysis was significantly higher. CAN was an independent predictor of all-cause and cardiovascular mortality, which highlights it as a risk stratification tool in patients with end-stage renal disease.

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“…The association between CAN and morbidity as well as mortality was also examined in other diseases that affect the autonomic nervous system. Apart from congenital diseases, such as familial dysautonomia and Ehlers-Danlos syndrome, 31 , 32 was associated with chronic obstructive pulmonary disease, 33 liver cirrhosis, 34 hypertension, and hyperuricemia. 35 In patients with chronic heart failure secondary to ischemic or idiopathic-dilated cardiomyopathy, the presence of , as identified by reduced uptake of metaiodobenzylguanidine labeled with iodine-123 or by pathological HRV measurements, was shown to predict all-cause mortality and sudden death.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study

Doulgerakis

Moyssakis

Kapelios

et al. 2017

Kidney International Reports

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IntroductionChronic renal disease is associated with increased cardiovascular (CV) mortality. Cardiac autonomic neuropathy (CAN) is predictive of mortality for diseases that affect the autonomic nervous system. We prospectively evaluated the prognostic value of indexes of left ventricular (LV) function and CAN in all-cause and CV mortality of patients with end-stage renal failure (ESRF).MethodsA total of 133 patients with ESRF were recruited. LV function was evaluated by echocardiography, whereas cardiac autonomic function was assessed using the battery of the 4 standardized tests proposed by Ewing.ResultsA total of 123 of 133 (92.5%) patients completed the study and were followed for a mean of 4.9 ± 2.6 years. Mean LV ejection fraction (LVEF) was 50.9 ± 6.9%, whereas 70 (57.9%) patients had CAN. Sixty-nine all-cause and 36 CV deaths were recorded. The survival rates at 3, 5, and 7 years were 77.2%, 57.4%, and 33.7%, respectively. Multivariate analysis after adjustment for waist circumference, current smoking, history of diabetes, and coronary artery disease demonstrated that the only independent predictors of all-cause mortality during follow-up were age, serum triglycerides, LVEF, and presence of CAN. Competing risk regression analysis, after adjusting for waist circumference, coronary heart disease, serum glucose, and triglycerides, indicated that age and presence of CAN were independent risk factors for CV mortality.DiscussionAge and presence of CAN are independent predictors of all-cause and CV mortality in patients with ESRF. The functionality of the cardiac autonomic nervous system activity can be used for the risk stratification in patients with ESRF.

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Cardiac autonomic neuropathy: The hidden cardiovascular comorbidity in elderly patients with chronic obstructive pulmonary disease attending primary care settings

Abstract: COPD has a complex spectrum of comorbidities. Cardiac autonomic neuropathy in elderly male patients with COPD correlated with hypercapnia, but not hypoxemia or the disease severity.

Cited by 9 publications

References 25 publications

<p>Long QT and death in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease is not related to electrolyte disorders</p>

<p>Long QT and death in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease is not related to electrolyte disorders</p>

Cardiovascular Autonomic Neuropathy and its Association with Cardiovascular and All-cause Mortality in Patients with End-stage Renal Disease

Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study

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