{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:58:33Z","timestamp":1777769913953,"version":"3.51.4"},"reference-count":28,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Heart Lung Foundation","award":["20251070"],"award-info":[{"award-number":["20251070"]}]},{"DOI":"10.13039\/501100005689","name":"Gothenburg Medical Society","doi-asserted-by":"crossref","award":["1022777"],"award-info":[{"award-number":["1022777"]}],"id":[{"id":"10.13039\/501100005689","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Konrad Helfrid Johansson Foundation"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,4,1]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>CATCH is a prospective observational cohort study enrolling adults (\u226518 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 (\u00b16) and 30 days (\u00b148\u2009hours). 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 (\u03b1=0.05, 80% power).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration details<\/jats:title>\n                    <jats:p>\n                      The CATCH study is registered at ClinicalTrials.gov (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06597331\">NCT06597331<\/jats:ext-link>\n                      ). The reference number for ethical approval is 2024-02071-01 (with addenda 2024-05448-02 and 2025-05861-02).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-004079","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:25:33Z","timestamp":1777479933000},"page":"e004079","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Assessment and Takotsubo-stunning among COPD-exacerbations in-Hospital (CATCH study): when the lungs break your heart\u2014protocol for a prospective observational cohort study"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct06597331","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06597331","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6422-604X","authenticated-orcid":false,"given":"Rickard","family":"Zeijlon","sequence":"first","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"},{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Zooq","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Poller","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lowie","family":"Vanfleteren","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linnea","family":"Molander","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mazdak","family":"Tavoly","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"},{"name":"Department of Research, \u00d8stfold Hospital Kalnes, Gr\u00e5lum, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"H\u00e4llgren Nordhage","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Westerlind","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N David","family":"\u00c5berg","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"},{"name":"Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"L\u00f6nnbro","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"},{"name":"Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0124-136X","authenticated-orcid":false,"given":"Micael","family":"Oliveira Diniz","sequence":"additional","affiliation":[{"name":"Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanya","family":"Said","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per","family":"Thysell","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Jha","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tore","family":"Hedb\u00e4ck","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"},{"name":"Department of Clinical Sciences, Lund University, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana","family":"Mincheva","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7771-7216","authenticated-orcid":false,"given":"Johan-Emil","family":"Bager","sequence":"additional","affiliation":[{"name":"Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Region V\u00e4stra G\u00f6taland, Sweden"},{"name":"Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026042909251312000_13.1.e004079.1","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1002\/ehf2.13165","article-title":"Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry","volume":"8","author":"Kato","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026042909251312000_13.1.e004079.2","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ijcard.2016.03.144","article-title":"Chronic obstructive lung disease exacerbation and takotsubo syndrome","volume":"214","author":"Madias","year":"2016","journal-title":"Int J Cardiol"},{"key":"2026042909251312000_13.1.e004079.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.66.6.1146"},{"key":"2026042909251312000_13.1.e004079.4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.tcm.2017.11.005","article-title":"Current interpretation of myocardial stunning","volume":"28","author":"Guaricci","year":"2018","journal-title":"Trends Cardiovasc Med"},{"key":"2026042909251312000_13.1.e004079.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy076"},{"key":"2026042909251312000_13.1.e004079.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy077"},{"key":"2026042909251312000_13.1.e004079.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(80)80129-8"},{"key":"2026042909251312000_13.1.e004079.8","unstructured":"Sato H , Tateishi H , Uchida T . Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama KHK , Hori M , eds. Clinical aspect of myocardial injury: from ischemia to heart failure (in Japanese). Tokyo: Kagakuhyoronsha Publishing Co, 1990: 56\u201364."},{"key":"2026042909251312000_13.1.e004079.9","first-page":"203","article-title":"Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases","volume":"21","author":"Dote","year":"1991","journal-title":"J Cardiol"},{"key":"2026042909251312000_13.1.e004079.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7133.2011.00210.x"},{"key":"2026042909251312000_13.1.e004079.11","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejim.2019.02.017","article-title":"Trigger factors in takotsubo syndrome - A systematic review of case reports","volume":"63","author":"Nyman","year":"2019","journal-title":"Eur J Intern Med"},{"key":"2026042909251312000_13.1.e004079.12","article-title":"Frequently Recurrent Takotsubo Syndrome in COPD","volume":"2019","author":"Vaz","year":"2019","journal-title":"Case Rep Cardiol"},{"key":"2026042909251312000_13.1.e004079.13","article-title":"Recurrent Stress Cardiomyopathy During COPD Exacerbation: Are Beta-adrenergic Agonists Only to Blame?","volume":"9","author":"Katsa","year":"2017","journal-title":"Cureus"},{"key":"2026042909251312000_13.1.e004079.14","doi-asserted-by":"crossref","DOI":"10.1093\/ehjopen\/oeac009","article-title":"Takotsubo syndrome and respiratory diseases: a systematic review","volume":"2","author":"Li","year":"2022","journal-title":"Eur Heart J Open"},{"key":"2026042909251312000_13.1.e004079.15","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.2147\/COPD.S267289","article-title":"The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy","volume":"15","author":"Li","year":"2020","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2026042909251312000_13.1.e004079.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.10.060"},{"key":"2026042909251312000_13.1.e004079.17","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S2213-2600(23)00461-7","article-title":"GOLD COPD report: 2024 update","volume":"12","author":"Venkatesan","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026042909251312000_13.1.e004079.18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4046\/trd.2022.0119","article-title":"Definition of Chronic Obstructive Pulmonary Disease Exacerbation: The Essentials of the Rome Proposal","volume":"86","author":"Oh","year":"2023","journal-title":"Tuberc Respir Dis (Seoul)"},{"key":"2026042909251312000_13.1.e004079.19","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.424"},{"key":"2026042909251312000_13.1.e004079.20","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics11081306","article-title":"Pulmonary Congestion Assessment in Heart Failure: Traditional and New Tools","volume":"11","author":"Pirrotta","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2026042909251312000_13.1.e004079.21","first-page":"566","article-title":"Killip scale reclassification according to lung ultrasound: Killip pLUS","volume":"13","author":"Carreras-Mora","year":"2024","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026042909251312000_13.1.e004079.22","doi-asserted-by":"publisher","DOI":"10.1164\/RCCM.202108-1819PP\/SUPPL_FILE\/DISCLOSURES.PDF"},{"key":"2026042909251312000_13.1.e004079.23","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S0140-6736(01)05620-3","article-title":"Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study","volume":"358","author":"Davies","year":"2001","journal-title":"The Lancet"},{"key":"2026042909251312000_13.1.e004079.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245824","article-title":"MultipleTesting.com: A tool for life science researchers for multiple hypothesis testing correction","volume":"16","author":"Menyhart","year":"2021","journal-title":"PLoS ONE"},{"key":"2026042909251312000_13.1.e004079.25","doi-asserted-by":"crossref","first-page":"338","DOI":"10.4330\/wjc.v6.i5.338","article-title":"Heart and lung, a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases: A systematic review","volume":"6","author":"Manfredini","year":"2014","journal-title":"World J Cardiol"},{"key":"2026042909251312000_13.1.e004079.26","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1159\/000369296","article-title":"Bronchogenic stress cardiomyopathy: a case series","volume":"130","author":"Rajwani","year":"2015","journal-title":"Cardiology"},{"key":"2026042909251312000_13.1.e004079.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.02.029"},{"key":"2026042909251312000_13.1.e004079.28","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ijcard.2020.12.047","article-title":"Clinical characteristics of patients with takotsubo syndrome recurrence: An observational study with long-term follow-up","volume":"329","author":"Arcari","year":"2021","journal-title":"Int J Cardiol"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-004079","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:25:40Z","timestamp":1777479940000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-004079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,4,29]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjresp-2025-004079"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-004079","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}