COPD maintenance therapy is related to left heart size: Results from the multicenter long-term observation COSYCONET

Background: In COPD, the extent of lung function impairment is related to reductions of left heart size. While short-term interventional trials showed counteracting effects of bronchodilators on cardiac parameters, it is unclear, whether this translates into the long term. Methods: Pooled data of GOLD grade 1-4 patients from visits 1 and 3 (1.5 y apart) of the long-term COSYCONET cohort (NCT01245933) were used. Medication was categorized as use of ICS, LABA+ICS, LABA+LAMA and LABA+LAMA+ICS (triple), contrasting “always” vs “never” use at both visits. Associations between medication and echocardiographic measures were identified by multiple regression and propensity score analysis. As covariates we included anthropometric, clinical, lung function (spirometry, bodyplethysmography, CO diffusing capacity) and cardiac comorbidity data. Results: 846 patients (mean age 64.5 y) were included, 53% using ICS at both visits, 51% LABA+ICS, 56% LABA+LAMA, 40% triple therapy. Conversely, 30%, 32%, 28% and 42% had no such therapy at both visits, respectively. The left atrial size showed significant associations, i.e. increases, with medication. Significant effects were linked to ICS, LABA+ICS and LABA+LAMA (p<0.05 each) and propensity score analyses underlined the role of LABA+LAMA. Conclusions: In this observational study, maintenance therapy in stable COPD, particularly LABA+LAMA, was linked to left atrial size, indicating an improved left heart filling. This is consistent with short-term interventional trials. The findings suggest that maintenance medication for COPD does not only improve lung function and patient reported outcomes but also impact on the heart.