Cardiac Dysfunction Indices and Their Prognostic Value in Acute Exacerbation COPD Patients

Abstract

Introduction: The aims of this study were to characterize the left ventricular dysfunction in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the role of the echocardiographic and biochemical cardiac dysfunction indices in predicting clinical outcome. Materials and Methods: This prospective cohort study was carried out on 37 AECOPD patients. Demographic and routine laboratory data were recorded. Clinical data; arterial blood gases; brain natriuretic peptide (BNP); echocardiographic examination including left ventricular (LV) systolic function, mitral valve E wave, mitral valve septal e′, E/e′ ratio (E/e′ ratio as the study LV diastolic dysfunction Index), and tricuspid annular plane systolic excursion were measured on admission and on discharge. Patients’ standard spirometric reports were cited. The patients were followed up in the intensive care unit till discharge. Results: There were high E velocities and E/e′ ratios (>14) on admission with significant improvement on discharge, whereas there were insignificant changes in LV systolic function and internal dimensions. About 51.4% of participant had BNP level between 100 and 500 pg/mL. Multivariate analysis showed that both admission BNP and E/e′ ratio were independent predictor of length of stay (R2 = 88.4% and P = .000, R2 = 98.1% and P = .000), and E/é ratio and tricuspid annular plane systolic excursion were independent predictors of elevated BNP (R2 = 0.930, P = .000, P = .009, respectively). None of the COPD obstructive values, admission hemodynamic parameters, and LV systolic indices had a significant impact. Reciever operating characteristic curve (ROC) analysis showed that BNP level >311 pg/mL and E/e′ ratio >15.3 were the significant predictive values for length of stay. Discussion: Most of the AECOPD patients had impaired LV diastolic function and elevated BNP levels that improved after control of the exacerbation. We recommend the use of BNP and E/e′ ratio to risk stratify the AECOPD patients.