Changes in biomarkers of cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease

Respir Med. 2018 Dec;145:192-199. doi: 10.1016/j.rmed.2018.11.008. Epub 2018 Nov 14.


Background: Cardiac dysfunction is associated with a higher mortality in exacerbations of chronic obstructive pulmonary disease (COPD). It is unknown how the heart responds to treatment of COPD exacerbations. We followed cardiac biomarker levels during hospital admissions for exacerbations of COPD and hypothesised that these biochemical markers of cardiac dysfunction might be affected the severity and treatment of exacerbations of COPD.

Methods: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin T were measured at admission, 12 h, 72 h, and clinical stability in 176 patients. In a second cohort (n = 93), associations between blood salbutamol concentrations and biomarker changes at 12 h were analysed.

Results: NT-proBNP increased from a geometric mean of 43 pmol/L at admission to 56 pmol/L at 12 h (p < 0.001), 53 pmol/L at 72 h (p = 0.045), and decreased to 25 pmol/L (p < 0.001) at stability. Troponin T levels decreased at 12 h (p < 0.001), but 15/174 (9%) patients had a clinically significant rise. Nebulised bronchodilator treatment and blood salbutamol concentrations were associated with greater increases in NT-proBNP rise at 12 h independently of baseline COPD or exacerbation severity and other treatments (p < 0.05). Nebulised bronchodilator and blood salbutamol concentrations also predicted rises in troponin T in univariate analyses (p < 0.05).

Conclusions: NT-proBNP continues to rise after admission to hospital for COPD exacerbations and a minority of patients have clinically significant rises in cardiac troponins. These rises were associated with nebulised beta2-agonist treatment. These findings suggest that high doses of beta2-agonists may exacerbate cardiac dysfunction in COPD.

Keywords: Beta(2)-agonist; Cardiac dysfunction; Chronic obstructive pulmonary disease; Natriuretic peptide; Troponin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenergic beta-2 Receptor Agonists / administration & dosage
  • Adrenergic beta-2 Receptor Agonists / adverse effects*
  • Adrenergic beta-2 Receptor Agonists / blood
  • Aged
  • Albuterol / administration & dosage
  • Albuterol / adverse effects*
  • Albuterol / blood
  • Biomarkers / blood
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / adverse effects*
  • Bronchodilator Agents / blood
  • Disease Progression
  • Female
  • Heart Diseases / diagnosis*
  • Heart Diseases / etiology*
  • Humans
  • Male
  • Natriuretic Peptide, Brain / blood*
  • Nebulizers and Vaporizers
  • Peptide Fragments / blood*
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Severity of Illness Index
  • Troponin T / blood*


  • Adrenergic beta-2 Receptor Agonists
  • Biomarkers
  • Bronchodilator Agents
  • Peptide Fragments
  • Troponin T
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Albuterol