The effect of tiotropium/olodaterol fixed-dose combination on cardiac function in patients with newly diagnosed moderate-to-severe chronic obstructive pulmonary disease

<bold>Background:</bold> Increased intrathoracic pressure in patients with chronic obstructive pulmonary disease (COPD) impairs cardiac function. Treatment with other dual bronchodilators showed a positive effect on cardiac parameters. <bold>Aims and objectives:</bold> To evaluate the efficacy of tiotropium/olodaterol (TIO/OLO) fixed-dose combination (FDC) on cardiac function in patients with moderate-to-severe COPD. <bold>Methods:</bold> We studied 18 subjects of 40-76 years-old with newly diagnosed moderate-to-severe COPD. Plethysmography and cardiac magnetic resonance imaging were performed at baseline and after 12 weeks of treatment with TIO/OLO FDC (recommended dose). <bold>Results:</bold> Hyperinflation was dominating over air-trapping alone (n=11 vs n=3). Plethysmography findings at baseline were as follows: median residual volume % of predicted (RV%) 155.5 (IQR 55), median RV to total lung capacity (TLC) ratio % of predicted (RV/TLC%) 132 (IQR 30), median forced residual capacity to TLC ratio % of predicted (FRC/TLC%) 119.5 (IQR 26). There was a tendency of a negative correlation between absolute RV/TLC and cardiac index (CI) (p=0.052; r=-0.465) at baseline. After 12 weeks of treatment, RV% and RV/TLC% decreased significantly (p=0.046 and p=0.016 respectively). We found that CI increased from 2.89 (IQR 1.09; baseline) to 3.21 L/min/m2 (IQR 0.78; week 12) (p=0.013). <bold>Conclusions:</bold> COPD treatment with TIO/OLO shows benefit in reducing air-trapping and improving cardiac function as measured by CI. As COPD patients have a higher risk for cardiovascular events, our study data emphasizes the importance of dual bronchodilation in patients with moderate-to-severe COPD.