Prospective Observational Study of Myocardial Stunning in Patients Hospitalized for Exacerbation of Chronic Obstructive Pulmonary Disease

PURPOSE

The purpose of Cardiac Assessment and Takotsubo-stunning among COPD-exacerbations in-Hospital (CATCH) is to investigate to what extent AE-COPD triggers Takotsubo-stunning in patients admitted to in-hospital care, and how this affects the outcome for these patients.

BACKGROUND

Acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) may cause acute heart failure due to stress-induced myocardial stunning, which is probably underdiagnosed or undiagnosed in clinical routine. Elements of myocardial stunning is associated with several conditions, however, the Takotsubo syndrome (TS) is probably a pure form of myocardial stunning. Therefore, the term "Takotsubo-stunning" is sometimes used to describe the myocardial stunning that occur in TS.

TS is an acute heart failure syndrome associated with emotional or physical stress predominately affecting females (>90% females) in the postmenopausal ages. TS is characterized by rapid onset of regional wall motion abnormality (typically widespread apical akinesia) and reversible left ventricular dysfunction. One of the most widely reported physical triggers of TS is AE-COPD and COPD is overrepresented among patients with TS. Concurrent respiratory disease such as AE-COPD complicate the diagnosis of TS, since the cardiac condition may be masked by pulmonary symptoms, and the respiratory symptoms may be further exacerbated by Takotsubo-stunning. Also, a cornerstone in the treatment for AE-COPD is high doses of beta-2-adrenergic agonists through inhalation. This may be unfavourable (and possibly detrimental) for a patient with Takotsubo-stunning, since adrenergic overstimulation in general, and overstimulation of cardiac beta-2-adrenergic receptor in particular, seems to be involved in the pathophysiology of TS.