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STATE-OF-THE-ART PAPER

Diagnostic and Therapeutic Challenges in Patients With Coexistent Chronic Obstructive Pulmonary Disease and Chronic Heart Failure

Thierry H. Le Jemtel, MD^_*,_*, Margherita Padeletti, MD and Sanja Jelic, MD

^_* Division of Cardiology, Tulane University, New Orleans, Louisiana
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York

Manuscript received June 19, 2006; revised manuscript received August 14, 2006, accepted August 14, 2006.

^_* Reprint requests and correspondence: Dr. Thierry H. Le Jemtel, Section of Cardiology, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, SL-48, New Orleans, Louisiana 70112-2699. (Email: lejemtel{at}tulane.edu).

Chronic obstructive pulmonary disease (COPD) and heart failure (CHF) are common conditions. The prevalence of COPD ranges from 20% to 30% in patients with CHF. The diagnosis of CHF can remain unsuspected in patients with COPD, because shortness of breath is attributed to COPD. Measurement of plasma B-type natriuretic peptide (BNP) levels helps to uncover unsuspected CHF in patients with COPD and clinical deterioration. Noninvasive assessment of cardiac function may be preferable to BNP to uncover unsuspected left ventricular (LV) systolic dysfunction in patients with stable COPD. Patients with COPD or CHF develop skeletal muscle alterations that are strikingly similar. Functional intolerance correlates with severity of skeletal muscle alterations but not with severity of pulmonary or cardiac impairment in COPD and CHF, respectively. Improvement of pulmonary or cardiac function does not translate into relief of functional intolerance in patients with COPD or CHF unless skeletal muscle alterations concomitantly regress. The mechanisms responsible for skeletal muscle alterations are incompletely understood in COPD and in CHF. Disuse and low-level systemic inflammation leading to protein synthesis/degradation imbalance are likely to contribute. The presence of COPD impacts on the treatment of CHF, as COPD is still viewed as a contraindication to beta-blockade. Therefore, COPD often deprives patients with CHF due to LV systolic dysfunction of the most beneficial pharmacologic intervention. A large body of data indicates that patients with COPD tolerate well selective beta-blockade that should not be denied to CHF patients with concomitant COPD.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   BB = beta-blockade   BNP = B-type natriuretic peptide   CHF = chronic heart failure   CI = confidence interval   COPD = chronic obstructive pulmonary disease   FEV1 = forced expiratory volume in 1 s   LV = left ventricular   SM = skeletal muscle

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