Inhalation COPD therapy is linked to left heart size: Results from COSYCONET on lung-heart interactions
Bibliographic record
Abstract
Background: Lung function impairment in COPD is known to be related to reductions of left heart size, while short-term interventional trials with bronchodilators showed positive effects on cardiac parameters. It is unclear, whether COPD maintenance therapy has similar long-term effects. Research question: To investigate long-term effects of COPD maintenance therapy on cardiac size and function in a retrospective, observational design. Study design and methods: Pooled data of GOLD grade 1 – 4 patients from visits 1 and 3 (1.5 y apart) of the COSYCONET cohort (NCT01245933) were used. Medication was categorized as use of ICS, LABA+ICS, LABA+LAMA and triple therapy (LABA+LAMA+ICS), contrasting “always” versus “never” at the two visits. Echocardiographic parameters comprised ventricular end-diastolic and -systolic diameter (LVEDD, LVESD), left ventricular ejection fraction (LVEF) and left atrial diameter (LA). Associations between medication and echocardiographic measures were identified by multiple regression analysis, as well as propensity score analysis. As covariates we included anthropometric, clinical (symptoms, exacerbations, smoking status), lung function (spirometry, bodyplethysmography, carbon monoxide diffusing capacity) and cardiac comorbidity/medication data. Results: Overall, 846 patients (mean age 64.5 y) were included, 53% using ICS at both visits, 51% LABA+ICS, 56% LABA+LAMA, 40% LABA+LAMA+ICS (triple) therapy. Conversely, 30%, 32%, 28% and 42% had no ICS, LABA+ICS, LABA+LAMA or triple therapy, respectively, at both visits. Among echocardiographic measures, only LA showed statistically significant associations (increases) with medication, whereby significant effects were linked to ICS, LABA+ICS and LABA+LAMA (p < 0.05 each, “always” versus “never”) and propensity score analyses underlined the role of LABA+LAMA. Interpretation: In this observational study, COPD maintenance therapy, especially LABA+LAMA, was linked to left atrial size, which is consistent with results of short-term interventional trials. The findings suggest that maintenance medication for COPD does not only improve lung function and patient reported outcomes but also has an impact on the cardiovascular system, particularly improving left heart filling. Publication History Article published online: 30 April 2021 © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".