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Carmen Pizarro,1,* Neele Herweg-Steffens,1,* Martin Buchenroth,2 Wolfgang Schulte,3 Christian Schaefer,1 Christoph Hammerstingl,1 Nikos Werner,1 Georg Nickenig,1 Dirk Skowasch1 1Department of Internal Medicine II – Cardiology, Pneumology and Angiology, University Hospital Bonn, Germany; 2Department of Pneumology, Johanniter Hospital Bonn, Germany; 3Department of Pneumology, Malteser Hospital Bonn/Rhein-Sieg, Germany *These authors contributed equally to this work Background: In acute exacerbation of COPD, increased plasma levels of cardiac troponin are frequent and associated with increased mortality. Thus, we aimed at prospectively determining the diagnostic value of coronary angiography in patients with exacerbated COPD and concomitantly elevated cardiac troponin. Patients and methods: A total of 88 patients (mean age 72.9±9.2 years, 56.8% male) hospitalized for acute exacerbation of COPD with elevated plasma troponin were included. All patients underwent coronary angiography within 72 hours after hospitalization. Complementary 12-lead electrocardiogram, transthoracic echocardiography, pulmonary function, and angiological testing were performed.Results: Coronary angiography objectified the presence of ischemic heart disease (IHD) in 59 patients (67.0%), of whom 34 patients (38.6% of total study population) underwent percutaneous coronary intervention. Among these 34 intervened patients, the vast majority (n=26, 76.5%) had no previously known IHD, whereas only eight out of 34 patients (23.5%) presented an IHD history. Patients requiring coronary intervention showed significantly reduced left ventricular ejection fraction (45.8%±13.1% vs 55.1%±13.3%, P=0.01) and a significantly more frequent electrocardiographic ST-segment depression (20.6% vs 7.4%, P=0.01). Neither additional laboratory parameters for inflammation and myocardial injury nor lung functional measurements differed significantly between the groups. Conclusion: Angiographically confirmed IHD that required revascularization occurred in 38.6% of exacerbated COPD patients with elevated cardiac troponin. In this considerable portion of patients, coronary angiography emerged to be of diagnostic and therapeutic value. Keywords: COPD, acute exacerbation, troponin elevation, coronary angiography, ischemic heart disease

This case study examines the proposed design of a new lecture/recital hall in Centennial Hall at Lynchburg College that will be used for lectures, public events, a film studies course, and musical recitals. It explores the audio-visual challenges presented by the differing acoustical requirements for the building. (EV)