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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The heart and lung are two closely related organs that collaborate in maintaining the metabolic balance of the body by participating in gas exchange and oxygen transport&#46; From a pathophysiological point of view&#44; these organs&#44; together with the kidney&#44; form a functional unit&#58; hypercapnia and hypoxemia modify ventricular preload&#44; afterload&#44; and diastolic function&#44; which can alter the distribution of renal vascular flow&#44; and participate in the hormonal control of the salt and water exchange&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> From a clinical point of view&#44; the failure of one of these organs can affect the functioning of the others and trigger compensation mechanisms where the cardinal symptom is usually dyspnea&#44; often accompanied by respiratory failure and alterations on chest X-ray&#46; In these situations&#44; the challenge for the clinician is to detect the level of dysfunction of each organ and the most appropriate therapeutic measures&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; occurs in up to 2&#37; of the adult population in developed countries&#44; and in up to 10&#37; of individuals over 70 years of age&#46; From a pathogenic point of view&#44; we can differentiate between two mechanisms&#58; 1&#46; Deficiencies in left ventricular contractility &#40;systolic dysfunction&#41; and 2&#46; Alterations in ventricular filling &#40;diastolic dysfunction&#41;&#46; In both cases&#44; the consequence is reduced cardiac output and&#47;or elevated pressure in the cardiac cavities&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Systolic dysfunction is generally caused by a primary heart problem&#44; while diastolic dysfunction has a more complex pathophysiological mechanism that presents with different phenotypes&#44; often related to the patient&#39;s overall comorbidity burden &#91;hypertension&#44; diabetes&#44; chronic kidney disease&#44; chronic obstructive pulmonary disease &#40;COPD&#41;&#44; and obesity&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical practice guidelines on the management of HF recommend performing echocardiography to assess left ventricular contractility and distinguish between systolic dysfunction &#40;left ventricular ejection fraction &#60;40&#37;&#41; and diastolic dysfunction&#46; In case of the latter&#44; clinical signs and symptoms&#44; natriuretic peptides&#44; and structural and functional data that can be extracted from the echocardiography should be taken into account&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">COPD is one of the most common diseases in respiratory medicine&#44; and it is estimated that up to 25&#37; of cases over 65 years of age present with concomitant HF&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Furthermore&#44; up to 30&#37; of patients with HF have COPD&#44; so the association between COPD and HF is well known and has been addressed in multiple publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> The coexistence of both diseases increases morbidity&#44; use of resources&#44; and mortality&#46; The diagnosis of COPD is based on demonstrating airflow obstruction&#44; but HF in itself can also induce spirometry alterations of both an obstructive and non-obstructive nature<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#58; all these factors complicate the diagnostic process&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Obesity is currently a public health problem closely related to respiratory diseases&#44; such as sleep apnea-hypopnea syndrome &#40;SAHS&#41;&#44; obesity-hypoventilation syndrome &#40;OHS&#41;&#44; or asthma&#46; Obese individuals show very diverse alterations in lung function tests<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and have an high risk of HF that can complicate the clinical picture in the presence of asthma&#44; SAHS&#44; or OHS&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> A recent study reported that up to 46&#37; of patients with stable OHS have hemodynamic alterations consistent with HF&#44; detected using cardiothoracic impedance&#44; a technique rarely used even in our specialty&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">HF is also associated with central apneas and breathing pattern changes in the form of Cheyne-Stokes respiration&#46; These cases require assessment and diagnostic studies in sleep units and sometimes need specific treatment with continuous positive airway pressure &#40;CPAP&#41; or Servo ventilators&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Servo ventilation is prescribed only in patients with normal left ventricular contractility&#44; so echocardiography is necessary&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">When considering diagnosis and communication with other professionals &#40;cardiologists&#41;&#44; it should be noted that lung function changes and respiratory failure are very well defined&#44; so the difference between normality and abnormality can be established with some clarity&#46; However&#44; the diagnosis of HF will often be based on a clinical syndrome and will require a combination of clinical&#44; analytical and radiological data&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The pulmonologist is then faced with diseases within the respiratory medicine spectrum in which HF may be present&#44; and must be detected&#44; evaluated&#44; and treated&#46; Despite the fact that the association of COPD and HF is well known&#44; it is clearly underestimated&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and we can only assume that HF occurring with obesity-related diseases will also present this problem&#46; Logically&#44; failure to diagnose leads to incomplete treatment&#44; so we could probably improve the prognosis of our COPD and OSH patients &#40;especially the most advanced cases&#41; by including the relevant cardiological examinations in our routine diagnostic processes&#46; The appropriate treatment for HF &#40;diuretics&#44; &#946;-blockers and&#47;or ACE inhibitors&#41; will then be added to the treatment for the associated disease&#46; It is worth mentioning &#946;-blockers here&#44; one of the key HF treatments that is often suspended in the presence of COPD&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Other chronic respiratory diseases that can affect lung function and gas exchange may also be associated with a certain degree of HF that constitutes a factor for exacerbations and the need for hospital admissions&#46; To establish the degree to which HF is involved in this process&#44; clinical&#44; analytical&#44; radiological&#44; and echocardiographic criteria will need to be applied&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; it seems clear that the high prevalence of HF means that many patients are treated not in cardiology units&#44; but rather in Primary Care&#44; Internal Medicine or Geriatrics&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a> We pulmonologists&#44; too&#44; will probably have to develop diagnostic and therapeutic skills&#44; and foster our communication with cardiologists&#46; The next challenge for our specialty will be to add basic echocardiography and non-invasive hemodynamic techniques&#44; such as cardiothoracic impedance&#44; to our procedures in order to more accurately characterize the cardiological status of our patients and thereby improve our knowledge and support of these diseases&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fern&#225;ndez &#193;lvarez R&#44; Rubinos Cuadrado G&#44; Molinos Martin L&#46; Insuficiencia card&#237;aca&#58; &#191;una patolog&#237;a neumol&#243;gica&#63; Arch Bronconeumol&#46; 2020&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.arbres.2020.04.009">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;arbres&#46;2020&#46;04&#46;009</span></p>"
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Editorial
Heart Failure: Is it a Lung Disease?
Insuficiencia cardíaca: ¿una patología neumológica?
Ramón Fernández Álvareza,
Corresponding author
enelllano@gmail.com

Corresponding author.
, Gemma Rubinos Cuadradoa, Luis Molinos Martinb
a Servicio de Neumología, Área de Pulmón, Hospital Universitario Central de Asturias, Oviedo, Spain
b Unidad de Neumología, Sanatorio Covadonga Gijon, Asturias, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The heart and lung are two closely related organs that collaborate in maintaining the metabolic balance of the body by participating in gas exchange and oxygen transport&#46; From a pathophysiological point of view&#44; these organs&#44; together with the kidney&#44; form a functional unit&#58; hypercapnia and hypoxemia modify ventricular preload&#44; afterload&#44; and diastolic function&#44; which can alter the distribution of renal vascular flow&#44; and participate in the hormonal control of the salt and water exchange&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> From a clinical point of view&#44; the failure of one of these organs can affect the functioning of the others and trigger compensation mechanisms where the cardinal symptom is usually dyspnea&#44; often accompanied by respiratory failure and alterations on chest X-ray&#46; In these situations&#44; the challenge for the clinician is to detect the level of dysfunction of each organ and the most appropriate therapeutic measures&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; occurs in up to 2&#37; of the adult population in developed countries&#44; and in up to 10&#37; of individuals over 70 years of age&#46; From a pathogenic point of view&#44; we can differentiate between two mechanisms&#58; 1&#46; Deficiencies in left ventricular contractility &#40;systolic dysfunction&#41; and 2&#46; Alterations in ventricular filling &#40;diastolic dysfunction&#41;&#46; In both cases&#44; the consequence is reduced cardiac output and&#47;or elevated pressure in the cardiac cavities&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Systolic dysfunction is generally caused by a primary heart problem&#44; while diastolic dysfunction has a more complex pathophysiological mechanism that presents with different phenotypes&#44; often related to the patient&#39;s overall comorbidity burden &#91;hypertension&#44; diabetes&#44; chronic kidney disease&#44; chronic obstructive pulmonary disease &#40;COPD&#41;&#44; and obesity&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical practice guidelines on the management of HF recommend performing echocardiography to assess left ventricular contractility and distinguish between systolic dysfunction &#40;left ventricular ejection fraction &#60;40&#37;&#41; and diastolic dysfunction&#46; In case of the latter&#44; clinical signs and symptoms&#44; natriuretic peptides&#44; and structural and functional data that can be extracted from the echocardiography should be taken into account&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">COPD is one of the most common diseases in respiratory medicine&#44; and it is estimated that up to 25&#37; of cases over 65 years of age present with concomitant HF&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Furthermore&#44; up to 30&#37; of patients with HF have COPD&#44; so the association between COPD and HF is well known and has been addressed in multiple publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> The coexistence of both diseases increases morbidity&#44; use of resources&#44; and mortality&#46; The diagnosis of COPD is based on demonstrating airflow obstruction&#44; but HF in itself can also induce spirometry alterations of both an obstructive and non-obstructive nature<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#58; all these factors complicate the diagnostic process&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Obesity is currently a public health problem closely related to respiratory diseases&#44; such as sleep apnea-hypopnea syndrome &#40;SAHS&#41;&#44; obesity-hypoventilation syndrome &#40;OHS&#41;&#44; or asthma&#46; Obese individuals show very diverse alterations in lung function tests<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and have an high risk of HF that can complicate the clinical picture in the presence of asthma&#44; SAHS&#44; or OHS&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> A recent study reported that up to 46&#37; of patients with stable OHS have hemodynamic alterations consistent with HF&#44; detected using cardiothoracic impedance&#44; a technique rarely used even in our specialty&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">HF is also associated with central apneas and breathing pattern changes in the form of Cheyne-Stokes respiration&#46; These cases require assessment and diagnostic studies in sleep units and sometimes need specific treatment with continuous positive airway pressure &#40;CPAP&#41; or Servo ventilators&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Servo ventilation is prescribed only in patients with normal left ventricular contractility&#44; so echocardiography is necessary&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">When considering diagnosis and communication with other professionals &#40;cardiologists&#41;&#44; it should be noted that lung function changes and respiratory failure are very well defined&#44; so the difference between normality and abnormality can be established with some clarity&#46; However&#44; the diagnosis of HF will often be based on a clinical syndrome and will require a combination of clinical&#44; analytical and radiological data&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The pulmonologist is then faced with diseases within the respiratory medicine spectrum in which HF may be present&#44; and must be detected&#44; evaluated&#44; and treated&#46; Despite the fact that the association of COPD and HF is well known&#44; it is clearly underestimated&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and we can only assume that HF occurring with obesity-related diseases will also present this problem&#46; Logically&#44; failure to diagnose leads to incomplete treatment&#44; so we could probably improve the prognosis of our COPD and OSH patients &#40;especially the most advanced cases&#41; by including the relevant cardiological examinations in our routine diagnostic processes&#46; The appropriate treatment for HF &#40;diuretics&#44; &#946;-blockers and&#47;or ACE inhibitors&#41; will then be added to the treatment for the associated disease&#46; It is worth mentioning &#946;-blockers here&#44; one of the key HF treatments that is often suspended in the presence of COPD&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Other chronic respiratory diseases that can affect lung function and gas exchange may also be associated with a certain degree of HF that constitutes a factor for exacerbations and the need for hospital admissions&#46; To establish the degree to which HF is involved in this process&#44; clinical&#44; analytical&#44; radiological&#44; and echocardiographic criteria will need to be applied&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; it seems clear that the high prevalence of HF means that many patients are treated not in cardiology units&#44; but rather in Primary Care&#44; Internal Medicine or Geriatrics&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a> We pulmonologists&#44; too&#44; will probably have to develop diagnostic and therapeutic skills&#44; and foster our communication with cardiologists&#46; The next challenge for our specialty will be to add basic echocardiography and non-invasive hemodynamic techniques&#44; such as cardiothoracic impedance&#44; to our procedures in order to more accurately characterize the cardiological status of our patients and thereby improve our knowledge and support of these diseases&#46;</p></span>"
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ISSN: 15792129
Original language: English
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