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Background <p>Atrial fibrillation (AF) frequently occurs in patients with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes. We aimed to identify patients at risk for AF using amplified p-wave duration (APWD) analysis on electrocardiogram (ECG) as non-invasive tool to diagnose an atrial cardiomyopathy (AtCM) which is an established risk factor for AF.</p> Methods <p>This subgroup analysis of the prospective COSYCONET cohort included 2,385 COPD patients from 31 study centers with baseline sinus rhythm ECG and at least one follow-up examination. Of these, 73 patients showed AF during follow-up and were propensity-score matched to controls. APWD was measured at baseline and future major adverse cardiac and cerebrovascular events (MACCE) and health related outcome were assessed.</p> Results <p>219 COPD patients (70 [64–74] years, 79.5% male) were analyzed during a follow-up of 586 (210–1137) days. APWD was significantly longer in patients with AF occurrence compared to controls (132 [125–141] ms vs. 124 [117–133] ms, <i>p</i> &lt; 0.001) and remained significant in multivariate regression analysis (OR: 1.05 [1.01–1.09], <i>p</i> = 0.03). An APWD ≥ 131&#xa0;ms was identified as best cut-off for AF prediction (62% sensitivity, 70% specificity, OR: 3.91 [2.58 to 5.95], <i>p</i> &lt; 0.001). Patients with AF had a significantly higher MACCE rate (24.7% versus 8.2%, <i>p</i> = 0.001) and a significantly lower physical activity score (1,074 [264–4,776] vs. 2,706 [975–7,339], <i>p</i> = 0.008).</p> Conclusions <p>This study demonstrates that ECG-based AtCM diagnosis identifies COPD patients at risk for AF, which was associated with a substantially elevated MACCE rate and a significantly reduced physical activity. This easy, cost-effective and widely available digital biomarker might enable early therapy initiation and prevention of adverse clinical outcomes.</p> Trial registration <p>NCT01245933 on Clinical-Trials.gov (Registration date: 22.11.2010).</p>

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ECG-based identification of COPD patients at risk for atrial fibrillation and its impact on adverse clinical outcomes—a subgroup analysis of the prospective multicenter COSYCONET cohort

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  • 发表日期：

    2025年9月17日

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  • Martin Eichenlaub,
  • Björn Christian Frye,
  • Heiko Lehrmann,
  • Frank Biertz,
  • Amir Sherwan Jadidi,
  • Klaus Kaier,
  • Thomas Melzer,
  • Peter Alter,
  • Henrik Watz,
  • Benjamin Waschki,
  • Barbara Christine Weckler,
  • Franziska Christina Trudzinski,
  • Julia Dorothea Michels-Zetsche,
  • Frederik Trinkmann,
  • Felix Josef-Friedrich Herth,
  • Hans-Ulrich Kauczor,
  • Kathrin Kahnert,
  • Rudolf Jörres,
  • Robert Bals,
  • Dirk Westermann,
  • Thomas Arentz,
  • Claus Franz Vogelmeier,
  • Daiana Stolz,
  • Sebastian Fähndrich,
  • Stefan Andreas,
  • Jürgen Behr,
  • Thomas Brahmer,
  • Burkhard Bewig,
  • Ralf Ewert,
  • Beate Stubbe,
  • Joachim Hans Ficker,
  • Christian Grohé,
  • Matthias Held,
  • Markus Henke,
  • Anne-Marie Kirsten,
  • Rembert Koczulla,
  • Juliane Kronsbein,
  • Cornelia Kropf-Sanchen,
  • Christian Herzmann,
  • Michael Pfeifer,
  • Winfried Johannes Randerath,
  • Werner Seeger,
  • Michael Studnicka,
  • Christian Taube,
  • Hartmut Timmermann,
  • Bernd Schmeck,
  • Tobias Welte,
  • Hubert Wirtz

摘要

Background

Atrial fibrillation (AF) frequently occurs in patients with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes. We aimed to identify patients at risk for AF using amplified p-wave duration (APWD) analysis on electrocardiogram (ECG) as non-invasive tool to diagnose an atrial cardiomyopathy (AtCM) which is an established risk factor for AF.

Methods

This subgroup analysis of the prospective COSYCONET cohort included 2,385 COPD patients from 31 study centers with baseline sinus rhythm ECG and at least one follow-up examination. Of these, 73 patients showed AF during follow-up and were propensity-score matched to controls. APWD was measured at baseline and future major adverse cardiac and cerebrovascular events (MACCE) and health related outcome were assessed.

Results

219 COPD patients (70 [64–74] years, 79.5% male) were analyzed during a follow-up of 586 (210–1137) days. APWD was significantly longer in patients with AF occurrence compared to controls (132 [125–141] ms vs. 124 [117–133] ms, p < 0.001) and remained significant in multivariate regression analysis (OR: 1.05 [1.01–1.09], p = 0.03). An APWD ≥ 131 ms was identified as best cut-off for AF prediction (62% sensitivity, 70% specificity, OR: 3.91 [2.58 to 5.95], p < 0.001). Patients with AF had a significantly higher MACCE rate (24.7% versus 8.2%, p = 0.001) and a significantly lower physical activity score (1,074 [264–4,776] vs. 2,706 [975–7,339], p = 0.008).

Conclusions

This study demonstrates that ECG-based AtCM diagnosis identifies COPD patients at risk for AF, which was associated with a substantially elevated MACCE rate and a significantly reduced physical activity. This easy, cost-effective and widely available digital biomarker might enable early therapy initiation and prevention of adverse clinical outcomes.

Trial registration

NCT01245933 on Clinical-Trials.gov (Registration date: 22.11.2010).