DOI: 10.1177/17534666261452491 ISSN: 1753-4666

Effects of dual bronchodilation on right ventricular function and troponin-I in newly diagnosed, moderate-to-severe chronic obstructive pulmonary disease: a prospective real-world observational study

Ieva Dimiene, Gintare Neverauskaite-Piliponiene, Paulius Bucius, Paulius Simkus, Lina Padervinskiene, Airidas Rimkunas, Egle Ereminiene, Skaidrius Miliauskas
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Background:

Chronic obstructive pulmonary disease (COPD) is associated with right ventricular (RV) dysfunction and subclinical myocardial injury. The effects of dual bronchodilation on RV function and cardiac injury biomarkers remain limited.

Objectives:

To evaluate 12-week changes in pulmonary function, RV function, and serum troponin-I in newly-diagnosed COPD patients receiving tiotropium/olodaterol as routine clinical care and to assess differences in RV function and troponin-I between COPD and non-COPD controls with comparable cardiovascular diseases (CVDs).

Design:

Prospective real-world observational study.

Methods:

Treatment-naïve patients with moderate-to-severe COPD were assessed at baseline and after 12 weeks of treatment. Evaluations included spirometry, plethysmography, two-dimensional and speckle-tracking transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), and troponin-I. Baseline RV measurements and troponin-I were compared between COPD ( n  = 47) and controls ( n  = 23).

Results:

COPD patients had lower RV fractional area change and RV free-wall strain (FWS) than controls ( p  < 0.001 and p  = 0.018, respectively). Troponin-I was above the limit of detection in 93.6% of COPD and in 56.5% of controls ( p  < 0.001). COPD treatment increased forced expiratory volume in 1 second (FEV 1 ) and forced vital capacity while reducing residual volume-to-total lung capacity (TLC) and functional residual capacity (FRC)-to-TLC ( p  < 0.05). RV global longitudinal strain (GLS) improved from 21.7 ± 2.6% to 23.0 ± 2.8%, and RV-FWS from 24.2 ± 3.3% to 26.1 ± 3.6% (both p  < 0.05) in echocardiography ( n  = 29). ΔRV-GLS correlated positively with ΔFEV 1 and inversely with ΔFRC/TLC ( p  < 0.05). In the moderate COPD subgroup, RV-GLS in MRI changed from 22.6 ± 6.1% to 25.5 ± 7.5% ( p  = 0.037), and troponin-I decreased from 1.23 pg/mL (IQR 1.03–1.56) to 1.09 pg/mL (IQR 0.95–1.20; p  = 0.049).

Conclusion:

COPD affects RV function and troponin-I regardless of concomitant CVDs. Initiation of dual bronchodilation is associated with beneficial effects on RV strain and troponin-I in patients with COPD. Because of the small sample size, these findings should be interpreted cautiously and confirmed in larger studies.

Trial registration:

ClinicalTrials.gov; ID NCT06072690; https://clinicaltrials.gov/study/NCT06072690 .

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