Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests’ results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests’ results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m² (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study.

Background/Objectives: Accurate assessment of pulmonary function is essential before planning radical lung cancer treatment. While spirometry reflects global lung function, perfusion imaging provides detailed information on regional perfusion patterns. This study aimed to characterize the pre-treatment profile of patients and compare the impact of surgical resection, radiotherapy, and thermal ablation on global pulmonary function and regional perfusion using SPECT/CT. Methods: In this prospective study of 68 patients, pre- and post-treatment assessments were conducted using lung perfusion SPECT/CT. While the entire cohort underwent imaging, longitudinal global pulmonary function (spirometry and gas diffusion) was analyzed for 45 patients who completed the three-month follow-up. Quantitative analysis included perfusion percentages and lung volumes, while a semi-quantitative scoring system evaluated the severity of perfusion defects. Results: In the overall cohort, the affected lung perfusion and volume significantly decreased (p = 0.002). Subgroup analysis revealed that the surgical resection group experienced significant reductions in perfusion (from 54.0% to 41.0%, p = 0.002) and volume (p < 0.001) of the affected lung, whereas no statistically significant changes were observed in the thermal ablation and radiotherapy groups (p > 0.05). Notably, 60.3% of patients presented with perfusion defects before treatment. Post-treatment spirometry parameters, particularly FEV1% (threshold 83.5%, AUC = 0.783), served as reliable predictors of persistent perfusion impairment. Conclusions: Radiotherapy and thermal ablation are lung-perfusion-sparing treatments compared to surgical resection. The high prevalence of pre-existing perfusion defects emphasizes the importance of incorporating lung perfusion SPECT/CT into routine pre-treatment evaluation to optimize treatment selection.

Background and Objectives: Dual bronchodilation in chronic obstructive pulmonary disease (COPD) has demonstrated beneficial effects on health-related quality of life (HRQoL) and exercise-related outcomes. Real-world evidence in treatment-naïve COPD remains limited. Materials and Methods: Forty-six COPD patients and 23 age-, gender-, BMI-, and cardiovascular comorbidity–matched controls underwent spirometry, plethysmography, symptom-limited incremental cardiopulmonary exercise testing (CPET), and the 36-item Short-Form Health Survey (SF-36). Following baseline assessment, COPD patients received tiotropium/olodaterol as part of routine practice. Thirty-two patients underwent repeated examinations at 12 weeks. Baseline differences between the COPD and control groups were assessed, and longitudinal changes in pulmonary function, CPET, and SF-36 were evaluated in COPD patients. Results: Compared with controls, COPD patients had lower peak oxygen uptake (VO₂; 17.4 ± 4.4 vs. 22.8 ± 4.5 mL/kg/min, p < 0.001) and oxygen pulse (11.5 ± 3.5 vs. 14.0 ± 2.4 mL/beat, p = 0.003), failed to reach 80% of predicted values, and exhibited worse ventilatory efficiency (p < 0.001). SF-36 scores in the COPD group were lower across all domains. After 12 weeks of tiotropium/olodaterol, pulmonary function improved significantly. CPET was performed at comparable efforts at both visits. Peak VO₂ increased from 70 ± 15 to 75 ± 16% predicted (p = 0.044), and peak oxygen pulse from 74 ± 16 to 79 ± 16% predicted (p = 0.015). VE/MVV decreased from 0.77 ± 0.23 to 0.69 ± 0.15 (p = 0.03). Higher baseline VE/MVV predicted a larger improvement after treatment (B = 0.71, p < 0.001), while beta-blocker use had no effect on the change of VE/MVV. SF-36 physical functioning and health change scores improved (both p < 0.01). Conclusions: At diagnosis, COPD was associated with impaired exercise physiology and reduced HRQoL. Dual bronchodilation improved exercise responses and perceived physical functioning. Beta-blocker use was not associated with changes in breathing reserve, supporting the use of cardioselective agents when indicated.

Background: Chronic obstructive pulmonary disease (COPD) is associated with right ventricular (RV) dysfunction and subclinical myocardial injury. The effects of dual bronchodilation on RV function and cardiac injury biomarkers remain limited. Objectives: To evaluate 12-week changes in pulmonary function, RV function, and serum troponin-I in newly-diagnosed COPD patients receiving tiotropium/olodaterol as routine clinical care and to assess differences in RV function and troponin-I between COPD and non-COPD controls with comparable cardiovascular diseases (CVDs). Design: Prospective real-world observational study. Methods: Treatment-naïve patients with moderate-to-severe COPD were assessed at baseline and after 12 weeks of treatment. Evaluations included spirometry, plethysmography, two-dimensional and speckle-tracking transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), and troponin-I. Baseline RV measurements and troponin-I were compared between COPD ( n = 47) and controls ( n = 23). Results: COPD patients had lower RV fractional area change and RV free-wall strain (FWS) than controls ( p < 0.001 and p = 0.018, respectively). Troponin-I was above the limit of detection in 93.6% of COPD and in 56.5% of controls ( p < 0.001). COPD treatment increased forced expiratory volume in 1 second (FEV ₁ ) and forced vital capacity while reducing residual volume-to-total lung capacity (TLC) and functional residual capacity (FRC)-to-TLC ( p < 0.05). RV global longitudinal strain (GLS) improved from 21.7 ± 2.6% to 23.0 ± 2.8%, and RV-FWS from 24.2 ± 3.3% to 26.1 ± 3.6% (both p < 0.05) in echocardiography ( n = 29). ΔRV-GLS correlated positively with ΔFEV ₁ and inversely with ΔFRC/TLC ( p < 0.05). In the moderate COPD subgroup, RV-GLS in MRI changed from 22.6 ± 6.1% to 25.5 ± 7.5% ( p = 0.037), and troponin-I decreased from 1.23 pg/mL (IQR 1.03–1.56) to 1.09 pg/mL (IQR 0.95–1.20; p = 0.049). Conclusion: COPD affects RV function and troponin-I regardless of concomitant CVDs. Initiation of dual bronchodilation is associated with beneficial effects on RV strain and troponin-I in patients with COPD. Because of the small sample size, these findings should be interpreted cautiously and confirmed in larger studies. Trial registration: ClinicalTrials.gov; ID NCT06072690; https://clinicaltrials.gov/study/NCT06072690 .

Background: Increased intrathoracic pressure in patients with chronic obstructive pulmonary disease (COPD) impairs cardiac function. Treatment with other dual bronchodilators showed a positive effect on cardiac parameters. Aims and objectives: To evaluate the efficacy of tiotropium/olodaterol (TIO/OLO) fixed-dose combination (FDC) on cardiac function in patients with moderate-to-severe COPD. Methods: We studied 18 subjects of 40-76 years-old with newly diagnosed moderate-to-severe COPD. Plethysmography and cardiac magnetic resonance imaging were performed at baseline and after 12 weeks of treatment with TIO/OLO FDC (recommended dose). Results: Hyperinflation was dominating over air-trapping alone (n=11 vs n=3). Plethysmography findings at baseline were as follows: median residual volume % of predicted (RV%) 155.5 (IQR 55), median RV to total lung capacity (TLC) ratio % of predicted (RV/TLC%) 132 (IQR 30), median forced residual capacity to TLC ratio % of predicted (FRC/TLC%) 119.5 (IQR 26). There was a tendency of a negative correlation between absolute RV/TLC and cardiac index (CI) (p=0.052; r=-0.465) at baseline. After 12 weeks of treatment, RV% and RV/TLC% decreased significantly (p=0.046 and p=0.016 respectively). We found that CI increased from 2.89 (IQR 1.09; baseline) to 3.21 L/min/m2 (IQR 0.78; week 12) (p=0.013). Conclusions: COPD treatment with TIO/OLO shows benefit in reducing air-trapping and improving cardiac function as measured by CI. As COPD patients have a higher risk for cardiovascular events, our study data emphasizes the importance of dual bronchodilation in patients with moderate-to-severe COPD.

Background/Objectives: Since 2015, pulmonary arterial hypertension (PAH)-specific medications have been fully reimbursed in Lithuania. To describe the current situation of PAH treatment in the country and to determine survival during different PAH treatment regimens. Methods: The data from the Institute of Hygiene and the State Data Agency of Lithuania cases with administrative codes I27.0 and I27.8 have been evaluated. Results: In 2025, 225 confirmed cases of PAH were treated with PAH-specific medications in two PH centers. At least one PAH-specific medication was prescribed to 163 (72.4%) female and 62 (27.6%) male patients. Among these, 96 (42.7%) received sildenafil monotherapy, 82 (36.4%) received a combination of sildenafil and an ERA, 36 (16.0%) were on triple PAH-specific therapy (including selexipag or treprostinil), and 11 (4.9%) received other regimens due to specific medical considerations. The age of adults treated with sildenafil monotherapy vs. other therapies was 63.9 ± 14.8 (n = 117) and 51.5 ± 17.3 (n = 116) years, respectively (p < 0.05). A total of 191 PAH patients who received targeted therapy died during the observational period 2017–2025. Of these, 105 received monotherapy, 57 sildenafil and endothelin receptor antagonist and 29 triple therapies (treprostinil [n = 19], selexipag [n = 6], or inhaled iloprost [n = 4] were prescribed as the third drug). Patients who died and received triple therapy were younger than those on mono- and dual therapy (age at diagnosis 45.0 ± 21.6, 67.2 ± 14.7 and 61.6 ± 16.3 years, respectively, p < 0.01). Survival was longer in patients on dual therapy compared with monotherapy (43.1 ± 28.1 vs. 31.7 ± 25.0 months, p = 0.04), and the longest was in those receiving triple therapy (59.9 ± 29.4 months; p < 0.05). Conclusions: The availability of reimbursed medications dramatically increased the number of treated PAH cases in Lithuania. In 2025, most of the PAH patients received sildenafil monotherapy. Patients treated with sildenafil only were significantly older than the rest of cohort. In the survival analysis, combination PAH therapies were more often prescribed to younger patients and were associated with longer duration of life than monotherapy.