COPD maintenance therapy may impact left atrial size

COPD maintenance therapy, particularly the combination of a long-acting beta agonist and long-acting muscarinic antagonist, was associated with left atrial size, according to an observational study published in Respiratory Medicine.

“[O]ur results appear consistent and in favor of the hypothesis that established COPD maintenance medication has beneficial long-term effects on the heart,” Peter Alter, MD, professor of medicine, department of pulmonary and critical care medicine, Philipps University of Marburg, Germany, and colleagues wrote.

The study included 846 patients (mean age, 64.5 years; 41% women) with COPD from the COPD and Systemic Consequences-Comorbidities Network (COSYCONET) cohort. Researchers pooled data of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade 1 to 4 patients from the first and third visits, which were conducted about 1.5 years apart. Patient medication use was categorized as use of inhaled corticosteroids (ICS); LABA plus ICS; LABA plus LAMA; and triple therapy consisting of LABA plus LAMA plus ICS. Researchers analyzed echocardiographic parameters including left ventricular end-diastolic and end-systolic diameter, left ventricular ejection fraction and left atrial diameter.

During both COSYCONET cohort visits, 53% of patients used ICS, 51% used LABA plus ICS, 56% used LABA plus LAMA and 40% used triple therapy. Thirty percent of patients reported no ICS use, 32% reported no LABA plus ICS use, 28% reported no LABA plus LAMA use and 42% reported no triple therapy use at both visits.

There was no significant association between COPD medication use and left ventricular end-diastolic diameter, left ventricular end-systolic diameter and left ventricular ejection fraction, according to the results.

Only left atrial diameter was significantly associated with COPD medication use, with significant effects linked to use of ICS only (P = .028), LABA plus ICS (P = .024) and LABA plus LAMA (P = .012 for all), but not with triple therapy (P = .059).

“In this observational study of GOLD 1-4 COPD patients evaluated by echocardiography, we detected positive cardiac effects from respiratory maintenance medication. Despite the presence of multiple functional and clinical factors that may have influenced the echocardiographic measures, we identified statistically significant effects of ICS, LABA plus ICS and especially LABA plus LAMA on the left atrial diameter. This is important since a reduced left atrial size is a sensitive indicator of an impaired filling in COPD, followed by reductions of left ventricular size, and contributing to dyspnea in COPD,” the researchers wrote.

The researchers noted several limitations of the study, including its cross-sectional design and no follow-up of participants at later visits.

“These findings suggest that prospective studies on long-term cardiac effects of respiratory maintenance medication in COPD could be promising,” the researchers wrote.