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Cardiac Assessment and Takotsubo-stunning among COPD-exacerbations in-Hospital (CATCH study) : when the lungs break your heart—protocol for a prospective observational cohort study

Zeijlon, Rickard ; Zooq, Sara ; Poller, Angela ; Vanfleteren, Lowie ; Molander, Linnea ; Andersson, Axel ; Tavoly, Mazdak ; Hällgren Nordhage, Peter ; Westerlind, Emma and Åberg, N. David , et al. (2026) In BMJ Open Respiratory Research 13(1).
Abstract

Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may cause stress-induced transient acute cardiac dysfunction through myocardial stunning, in the form of exacerbation-triggered Takotsubo syndrome (referred to as Takotsubo stunning). Although prior studies suggest an association between AECOPD and transient cardiac dysfunction, existing evidence is limited to retrospective cohorts, case reports and expert consensus. Therefore, the incidence and clinical impact of Takotsubo stunning with acute heart failure (AHF) during AECOPD remain unknown and may be overlooked due to overlapping clinical symptoms. Cardiac Assessment and Takotsubo-stunning among COPD-exacerbations in-Hospital (CATCH study) aims to... (More)

Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may cause stress-induced transient acute cardiac dysfunction through myocardial stunning, in the form of exacerbation-triggered Takotsubo syndrome (referred to as Takotsubo stunning). Although prior studies suggest an association between AECOPD and transient cardiac dysfunction, existing evidence is limited to retrospective cohorts, case reports and expert consensus. Therefore, the incidence and clinical impact of Takotsubo stunning with acute heart failure (AHF) during AECOPD remain unknown and may be overlooked due to overlapping clinical symptoms. Cardiac Assessment and Takotsubo-stunning among COPD-exacerbations in-Hospital (CATCH study) aims to determine the incidence of Takotsubo stunning during AECOPD and to evaluate its clinical implication. Methods and analysis: CATCH is a prospective observational cohort study enrolling adults (≥18 years) admitted for AECOPD at Sahlgrenska University Hospital (Gothenburg, Sweden). Participants with chronic left ventricular systolic dysfunction (left ventricular ejection fraction <50%), pre-existing chronic regional wall motion abnormalities (RWMA) or prior type 1 myocardial infarction are excluded. Following informed consent, participants undergo echocardiographic screening for RWMA and/or systolic left ventricular dysfunction. Screening-positive patients have follow-up echocardiography at 24 hours (±6) and 30 days (±48 hours). Those with reversible dysfunction constitute the CATCH case group, while screening-negative participants serve as controls. Additional assessments include ECG, chest X-ray, N-terminal pro-B-type natriuretic peptide blood analysis and COPD severity. Primary outcomes include the incidence of reversible RWMA or left ventricular dysfunction (proxy for Takotsubo stunning) and in-hospital clinical signs of AHF (Killip class >1). A sample size of 150 patients is required for detecting AHF differences (α=0.05, 80% power). Ethics and dissemination: The study received ethical approval from the Swedish Ethical Review Authority. All participants provided written informed consent. Results will be disseminated through peer-reviewed journals and scientific meetings. Registration details: The CATCH study is registered at ClinicalTrials.gov (NCT06597331). The reference number for ethical approval is 2024-02071-01 (with addenda 2024-05448-02 and 2025-05861-02).

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Contribution to journal
publication status
published
subject
keywords
COPD, COPD Exacerbations, COPD Pathology, Imaging/CT MRI etc, Patient Outcome Assessment, Pulmonary Disease, Chronic Obstructive
in
BMJ Open Respiratory Research
volume
13
issue
1
article number
e004079
publisher
BMJ Publishing Group
external identifiers
  • scopus:105037561841
  • pmid:42055737
ISSN
2052-4439
DOI
10.1136/bmjresp-2025-004079
language
English
LU publication?
yes
id
e77a69ff-e751-4efe-9b5b-735bfe7e8e75
date added to LUP
2026-07-08 09:53:23
date last changed
2026-09-02 14:55:12
@article{e77a69ff-e751-4efe-9b5b-735bfe7e8e75,
  abstract     = {{<p>Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may cause stress-induced transient acute cardiac dysfunction through myocardial stunning, in the form of exacerbation-triggered Takotsubo syndrome (referred to as Takotsubo stunning). Although prior studies suggest an association between AECOPD and transient cardiac dysfunction, existing evidence is limited to retrospective cohorts, case reports and expert consensus. Therefore, the incidence and clinical impact of Takotsubo stunning with acute heart failure (AHF) during AECOPD remain unknown and may be overlooked due to overlapping clinical symptoms. Cardiac Assessment and Takotsubo-stunning among COPD-exacerbations in-Hospital (CATCH study) aims to determine the incidence of Takotsubo stunning during AECOPD and to evaluate its clinical implication. Methods and analysis: CATCH is a prospective observational cohort study enrolling adults (≥18 years) admitted for AECOPD at Sahlgrenska University Hospital (Gothenburg, Sweden). Participants with chronic left ventricular systolic dysfunction (left ventricular ejection fraction &lt;50%), pre-existing chronic regional wall motion abnormalities (RWMA) or prior type 1 myocardial infarction are excluded. Following informed consent, participants undergo echocardiographic screening for RWMA and/or systolic left ventricular dysfunction. Screening-positive patients have follow-up echocardiography at 24 hours (±6) and 30 days (±48 hours). Those with reversible dysfunction constitute the CATCH case group, while screening-negative participants serve as controls. Additional assessments include ECG, chest X-ray, N-terminal pro-B-type natriuretic peptide blood analysis and COPD severity. Primary outcomes include the incidence of reversible RWMA or left ventricular dysfunction (proxy for Takotsubo stunning) and in-hospital clinical signs of AHF (Killip class &gt;1). A sample size of 150 patients is required for detecting AHF differences (α=0.05, 80% power). Ethics and dissemination: The study received ethical approval from the Swedish Ethical Review Authority. All participants provided written informed consent. Results will be disseminated through peer-reviewed journals and scientific meetings. Registration details: The CATCH study is registered at ClinicalTrials.gov (NCT06597331). The reference number for ethical approval is 2024-02071-01 (with addenda 2024-05448-02 and 2025-05861-02).</p>}},
  author       = {{Zeijlon, Rickard and Zooq, Sara and Poller, Angela and Vanfleteren, Lowie and Molander, Linnea and Andersson, Axel and Tavoly, Mazdak and Hällgren Nordhage, Peter and Westerlind, Emma and Åberg, N. David and Lönnbro, Johan and Oliveira Diniz, Micael and Said, Kanya and Thysell, Per and Jha, Sandeep and Hedbäck, Tore and Mincheva, Roxana and Bager, Johan Emil}},
  issn         = {{2052-4439}},
  keywords     = {{COPD; COPD Exacerbations; COPD Pathology; Imaging/CT MRI etc; Patient Outcome Assessment; Pulmonary Disease, Chronic Obstructive}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open Respiratory Research}},
  title        = {{Cardiac Assessment and Takotsubo-stunning among COPD-exacerbations in-Hospital (CATCH study) : when the lungs break your heart—protocol for a prospective observational cohort study}},
  url          = {{http://dx.doi.org/10.1136/bmjresp-2025-004079}},
  doi          = {{10.1136/bmjresp-2025-004079}},
  volume       = {{13}},
  year         = {{2026}},
}