Targeting occult heart failure in intensive care unit patients with acute chronic obstructive pulmonary disease exacerbation: effect on outcome and quality of life.

PURPOSE: To estimate the prevalence of previously undiagnosed heart failure in mechanically ventilated patients with severe exacerbation of chronic obstructive pulmonary disease (COPD) and to evaluate the impact of specific heart failure treatment on patients' outcome.

MATERIALS AND

METHODS

In this prospective study, we included 107 consecutive patients with COPD without known history of cardiac disease who were admitted to the intensive care unit (ICU) because of hypercapnic respiratory failure leading to mechanical ventilation.

RESULTS

Patients were divided into 4 groups according to the echocardiographic findings: patients with isolated right or left ventricular failure, biventricular failure, and normal heart function. Three of 4 patients demonstrated findings of heart failure. In 41%, the presence of previously unrecognized left ventricular dysfunction was revealed. Patients with isolated left ventricular dysfunction experienced less days on mechanical ventilation, less intensive care unit days, improved quality of life, and decreased in-hospital and 6-month mortality compared with patients with normal heart.

CONCLUSIONS

In mechanically ventilated patients with severe exacerbation of COPD, unrecognized left or right ventricular failure is common. Among patients with isolated left ventricular failure, the early detection and appropriate treatment improves long-term quality of life and may decrease the short- and 6-month morbidity and mortality.