Cardiovascular Events During and After Bronchiectasis Exacerbations and Long-term Mortality

Raúl Méndez; Laura Feced; Victoria Alcaraz-Serrano; Paula González-Jiménez; Leyre Bouzas; Ricardo Alonso; Luis Martínez-Dolz; David Hervás; Laia Fernández-Barat; Antoni Torres; Rosario Menéndez

doi:10.1016/j.chest.2021.10.013

Cardiovascular Events During and After Bronchiectasis Exacerbations and Long-term Mortality

Chest. 2022 Mar;161(3):629-636. doi: 10.1016/j.chest.2021.10.013. Epub 2021 Oct 15.

Affiliations

¹ Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections Research Group, Health Research Institute La Fe, Valencia, Spain. Electronic address: mendez_rau@gva.es.
² Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections Research Group, Health Research Institute La Fe, Valencia, Spain; University of Valencia, Valencia, Spain.
³ Pneumology Department, University Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Center for Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain.
⁴ Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections Research Group, Health Research Institute La Fe, Valencia, Spain.
⁵ Laboratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
⁶ Cardiology Department, La Fe University and Polytechnic Hospital, Health Research Institute La Fe, Valencia, Spain; Center for Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
⁷ Data Science, Biostatistics & Bioinformatics, Health Research Institute La Fe, Valencia, Spain; Department of Applied Statistics and Operational Research and Quality, Universitat Politècnica de València, Valencia, Spain.
⁸ Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections Research Group, Health Research Institute La Fe, Valencia, Spain; University of Valencia, Valencia, Spain; Center for Biomedical Research Network in Respiratory Diseases (CIBERES), Madrid, Spain.

PMID: 34656526
DOI: 10.1016/j.chest.2021.10.013

Abstract

Background: Population-based and retrospective studies have shown that risk for cardiovascular events such as arrythmias, ischemic episodes, or heart failure, increase during and after bronchiectasis exacerbations.

Research question: What are the risk factors for cardiovascular events (CVE) during and after bronchiectasis exacerbations and their impact on mortality?

Study design and methods: This was a post hoc retrospective analysis of a prospective observational study of 250 patients with bronchiectasis at two tertiary care hospitals. Only the first exacerbation was considered for each patient, collecting demographic, comorbidity, and severity data. The main outcomes were the appearance of CVE and mortality. Risk factors for CVE were analyzed using a semi-competing risks model.

Results: During a median follow-up of 35 months, 74 (29.6%) patients had a CVE and 93 (37.2%) died. Semi-competing risk analysis indicated that age, arterial hypertension, COPD, and potentially severe exacerbations significantly increased the risk for developing CVE. Compared with patients without CVE, those with CVE had higher mortality.

Interpretation: Demographic factors and comorbidities are risk factors for the development of CVE after an acute exacerbation of bronchiectasis. The appearance of CVE worsens long-term prognosis.

Keywords: bronchiectasis; cardiovascular; exacerbations; mortality; proadrenomedullin.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Bronchiectasis*
Cardiovascular Diseases* / etiology
Humans
Prognosis
Retrospective Studies
Risk Factors