ArticleCureus2025
Association of N-terminal Pro-B-Type Natriuretic Peptide Levels and Electrocardiogram Changes With the Severity of Airflow Narrowing and Exercise Tolerance in Stable Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Analytical Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Cardiac biomarkers in athletes and active individuals: a clinical review of exercise-induced elevations and diagnostic interpretation.Frontiers in physiology · 2026Review
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Abstract
backgroundChronic obstructive pulmonary disease (COPD) is associated with significant cardiovascular morbidity. N-terminal pro-B-type natriuretic peptide (NT-proBNP), electrocardiogram (ECG) abnormalities, and reduced exercise tolerance may reflect cardiac involvement in COPD, but their relationship with airflow limitation stages is incompletely defined. This study evaluated associations between NT-proBNP, ECG changes, and six-minute walk distance (6MWD) across the Global Initiative for Obstructive Lung Disease (GOLD) stages in stable COPD patients.
methodsA hospital-based cross-sectional analytical study enrolled 88 stable COPD patients aged ≥40 years between October 2022 and June 2024. Demographic, clinical, spirometric, ECG, 6MWD, and NT-proBNP data were collected. COPD severity was classified by the GOLD criteria. Continuous variables were compared by analysis of variance (ANOVA) and categorical variables by the chi-squared test. A p-value of <0.05 indicated statistical significance.
resultsOf 88 participants, 71 (80.7%) were male and 17 (19.3%) female. Distribution by GOLD stage was as follows: GOLD I 20 (22.7%), GOLD II 39 (44.3%), GOLD III 22 (25%), and GOLD IV seven (8%). Exercise capacity declined with severity: the mean 6MWD decreased markedly from the mild to the very severe groups. NT-proBNP levels rose progressively with airflow limitation (ANOVA p < 0.001), with markedly higher mean concentrations in the very severe group. ECG abnormalities increased with disease stage: P pulmonale was present in 24 (27.3%), right ventricular hypertrophy in 27 (30.7%), right axis deviation in 27 (30.7%), low voltage complexes in eight (9.1%), and incomplete right bundle branch block (IRBBB) in five (5.7%) of the cohort; these changes were more frequent in severe/very severe COPD. Smoking exposure and indices (current/former smokers, cigarettes/day, smoking index, duration) showed significant upward trends with worsening GOLD stage (p ≤ 0.042). NT-proBNP correlated positively with COPD stage, while 6MWD correlated negatively (r values significant; p < 0.001).
conclusionIn stable COPD, advancing airflow limitation is associated with rising NT-proBNP, increasing ECG evidence of right heart strain, and declining exercise tolerance. NT-proBNP and simple ECG markers, alongside functional testing, may aid the early detection of cardiovascular involvement in COPD and help risk-stratify patients for closer cardiopulmonary evaluation and management.
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