Abstract
BackgroundExercise intolerance is common in patients with chronic obstructive pulmonary disease (COPD), which has multiple mechanisms underlying its progression. Ventricular dysfunction may play a role in the development of exercise incapacity in patients with COPD.AimTo investigate the possible contribution of left ventricular (LV) and right ventricular (RV) dysfunction (either systolic or diastolic) in development of exercise intolerance in patients with COPD.Patients and methodsA total of 60 patients with diagnosis of COPD were categorized according to GOLD spirometric stage into two groups (group 1: mild to moderate COPD, and group 2: severe to very severe COPD). Both groups were evaluated by spirometry, ECG, chest radiography, routine laboratory investigation, 6-min walk test, and echocardiography including tissue Doppler imaging.ResultsThe average age in the whole study group was 56.63 ±10.33 years. Male patients in the study were 46 (76.7%) and female patients were 14 (23.3%). Mean maximum walk distance among the whole group was 342.75±54.85 m. There was a significant correlation between 6-min walk distance and transtricuspid E velocity, tricuspid E/A, and transtricuspid deceleration time (P=0.011, 0.015, and 0.021, respectively). There was no significant correlation between 6-min walk distance and parameters of LV diastolic dysfunction. Prevalence of ventricular dysfunction was as follow: LV systolic dysfunction 3.3%, LV diastolic dysfunction 30%, RV systolic dysfunction 21%, and RV diastolic dysfunction 46%.ConclusionRV diastolic dysfunction may be a contributing factor in the progression of exercise intolerance in COPD. Although LV diastolic dysfunction may not be associated with exercise intolerance, it is still prevalent in COPD and must be assessed and managed through the course of the disease and especially during exacerbation.
Highlights
Chronic obstructive pulmonary disease (COPD) is on its way to be the third most common killer disease worldwide by 2020 [1,2]
There was no significant correlation between 6-min walk distance and parameters of left ventricular (LV) diastolic dysfunction
There was a significant correlation between 6-min walk distance and TAPSE in mild to moderate chronic obstructive pulmonary disease (COPD)
Summary
Chronic obstructive pulmonary disease (COPD) is on its way to be the third most common killer disease worldwide by 2020 [1,2]. Exercise intolerance is common in patients with COPD, which has multiple mechanisms underlying its progression. Increased ventilatory demand, associated with altered dynamic mechanics, abnormal gas exchange, airway limitation, and peripheral muscle dysfunction, is among the intrinsic pulmonary mechanisms that are alleged for exercise incapacity seen in such patients [11,12,13,14,15]. There is increasing evidence that ventricular dysfunction may play a role in development of exercise intolerance in patients with COPD. Exercise intolerance is common in patients with chronic obstructive pulmonary disease (COPD), which has multiple mechanisms underlying its progression. Ventricular dysfunction may play a role in the development of exercise incapacity in patients with COPD
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