Five-year mortality in patients with COPD and Impaired left ventricular filling

<bold>Rationale:</bold> In COPD, impaired left ventricular (LV) filling might be associated with coexisting HFpEF or due to reduced pulmonary venous return by emphysema, indicated by small LV size. <bold>Objective:</bold> We investigate the all-cause mortality associated with small LV or HFpEF. <bold>Methods:</bold> We performed transthoracic echocardiography (TTE) in patients from the COPD-COSYCONET cohort to define small LV, HFpEF and normal cardiac function (normalTTE) according to ESC recommendations. The primary outcome was all-cause mortality after five year. <bold>Results:</bold> In 1752 patients with COPD, the frequency of small LV, HFpEF-features, and normalTTE was 8%, 16%, and 45%, respectively. Patients with small LV or HFpEF-features had higher all-cause mortality rates than patients with normalTTE, HR: 2.75; (95% CI: [1.54 - 4.89]) and 2.16 (95% CI: [1.30 - 3.61]). A sensitivity analysis in a subgroup with frank HFpEF (n=85) confirmed the later finding, HR: 3.18 (95% CI: [1.64 - 6.15]). Small LV remained an independent predictor of all-cause mortality after adjusting for common COPD mortality predictors. Compared to normalTTE, patients with small LV had reduced LV filling (lower E/A), yet in contrast to patients with HFpEF, patients with small LV had normal LV filling pressure (NT-pro-BNP, E/e’). <bold>Conclusion:</bold> In COPD, both small LV and HFpEF are associated with increased all-cause mortality and represent two distinct patterns of impaired LV filling. <fig><object-id>erj;64/suppl_68/PA2956/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>