Clinical and functional features of chronic obstructive pulmonary disease with concomitant atrial fibrillation

Abstract

   Aim.  To study the clinical and functional features and course of chronic obstructive pulmonary disease (COPD) depending on the presence or absence of atrial fibrillation (AF), establish the impact of AF on hemodynamic parameters and lung function in these patients, and evaluate the efficacy of an angiotensin receptor-neprilysin inhibitor (ARNI) in COPD patients with AF.    Materials and methods.  A total of 60 patients with COPD were examined (85.0 % male; mean age 67.2 ± 4.1 years). The patients were divided into two groups: Group 1 (n = 28) comprised individuals with concomitant permanent AF receiving ARNI (sacubitril/valsartan at a starting dose of 100 mg/day) as part of quadruple therapy; the Group 2 (n = 32) consisted of patients with preserved sinus rhythm. All enrolled subjects underwent comprehensive clinical, laboratory, and instrumental examination.    Results.  At hospitalization, patients in Group 1 exhibited a more severe course of COPD: lower forced expiratory volume in 1 second (FEV1; p < 0.05) and a higher frequency of annual exacerbations (p < 0.01). According to the modified Medical Research Council (mMRC) scale, they demonstrated pronounced dyspnea, and in the 6-minute walk test (6MWT), they covered the shortest distance (p < 0.05). At baseline, Group 1 showed significantly elevated levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) compared to Group 2 (p < 0.001), against the background of reduced glomerular filtration rate (GFR; p < 0.01) and more pronounced cardiac remodeling (p < 0.05). The inclusion of ARNI in quadruple therapy resulted in a significant increase in ejection fraction (EF) of both ventricles, reduction in intracardiac volumes (p < 0.01), decreased NT-proBNP levels (p < 0.001), and improved GFR (p < 0.05).    Conclusion.  The use of ARNI in COPD patients with concomitant AF contributes to a significant improvement in clinical status, accompanied by a reduction in dyspnea and increased exercise tolerance. In comorbid COPD and AF patients, inclusion of ARNI in standard medical therapy is advisable to improve hemodynamic parameters and reduce the risk of complications.