Study on LV Systolic Dysfunction in COPD Patients

A recent study has suggested that subclinical left ventricular (LV) systolic dysfunction is likely to be detected when measured by tissue Doppler imaging (TDI), in COPD patients and even in patients without pulmonary hypertension (PH).

The study results have been published in PLoS ONE.

Researchers pointed out that in chronic obstructive pulmonary disease (COPD), and in particular in those with severe emphysema, pulmonary hypertension, and right ventricular (RV) enlargement, the left ventricle is compressed. However, LV ejection fraction by two-dimensional echocardiography can be normal despite LV dysfunction.

Tissue Doppler imaging (TDI) is a more sensitive tool to detect subclinical systolic LV dysfunction.

Janne M. Hilde and a team from the Department of Cardiology, Oslo University Hospital-Aker, Norway, carried out the study to assess the prevalence of left ventricular (LV) systolic and diastolic function in a stable cohort of COPD patients, where LV disease had been thoroughly excluded in advance.

The sample population included a hundred outpatients with stable COPD of different severity and free of clinical cardiovascular disease from 2006 to 2010. The diagnosis of COPD was based on a history of cigarette smoking with at least 10 pack-years and spirometry irreversible airway obstruction according to current guidelines. The COPD patients were compared to an age and gender-matched control group (n = 34) and evaluated healthy by clinical, biochemical, and imaging investigations.

All study patients underwent a comprehensive Doppler echocardiographic examination before and within 120 minutes of right-heart catheterization.

Key Findings

• LV MPI ≥0.51 was found in 64.9% and 88.5% and LV strain ≤-15.8% in 62.2% and 76.9% in the COPD-non-PH and COPD-PH patients, respectively.
• Similarly, LV MPI and LV strain were impaired even in patients with mPAP <20 mmHg.
• In multiple regression analyses, residual volume and stroke volume were best associated with LV MPI and LV strain, respectively.
• Except for isovolumic relaxation time, standard diastolic echo indices as E/A, E´, E/E´, and left atrium volume did not change from normal individuals to COPD-non-PH.

"Subclinical LV systolic dysfunction was a frequent finding in this cohort of COPD patients, even in those with normal pulmonary artery pressure. Evidence of LV diastolic dysfunction was hardly present as measured by conventional echo indices," authors said.

For the full article, click on the link: https://doi.org/10.1371/journal.pone.0235075

Primary source: PLoS ONE