Echocardiographic predictors for stress induced right ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease

Abstract

Background: Pulmonary vasculopathy, right heart structural and functional abnormalities occur even in normoxemic chronic obstructive pulmonary disease patients. Despite of being associated with functional limitation, exacerbations and disease progression, their detection and proper management is still delayed. Aim: Our aim was to establish the frequency of stress induced right ventricular diastolic dysfunction (RVDD) in non-severe COPD patients, free of clinically overt cardiovascular diseases (ischaemic heart disease, heart failure, uncontrolled arterial hypertension), who complain of exertional dyspnea and to look for echocardiographic predictors of it. Materials and method: We applied cardio-pulmonary exercise testing (CPET) in 104 non-severe, COPD patients. A ramp protocol was performed. Echocardiography was done before and 1-2 minutes after peak exercise. Cut-off values for stress induced RVDD were right ventricular (RV) E/e’ ratio > 6, measured by PWD of the tricuspid valve. Receiver operating curves were constructed for echo parameters at rest to determine if any of them may discriminate stress induced RV E/e’ > 6 or &лt; 6. Uni- and multivariable linear regression analysis was also performed to assess the predictive power of each of them. Results: 78% of the patients had stress induced RVDD. RAVI (cut-off > 20.55 ml/m2; sensitivity – 86%; specifi city – 86%), RVWT (cut-off > 5.25 mm; sensitivity – 100%; specifi city – 63%) and RV E/A ratio at rest (cut-off > 1.05; sensitivity – 79.7%; specifi city – 90.5%) were the best predictors of stress RV E/e. In univariate regression analysis RV E/A showed the highest OR 19.73; (95% CI – 18.52-21.01); followed by RAVI – OR 3.82; (95% CI – 2.04-7.14). Conclusion: There is a high prevalence of stress induced RVDD in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. RAVI, RVWT, RV E/A and RV E/e’ ratio at rest may be used as predictors for stress RVDD and may facilitate patients’ risk stratifi cation and proper management.