Abstract
BackgroundPulmonary vasculopathy, right heart structural and functional abnormalities occur even in normoxemic chronic obstructive pulmonary disease (COPD) patients. Despite being associated with functional limitation, exacerbations, and disease progression, their detection and proper management is still delayed. AimOur aim was to establish the frequency of stress-induced right ventricular diastolic dysfunction (RVDD) in non-severe COPD patients, free of overt cardiovascular disease, who complain of exertional dyspnea and to look for echocardiographic predictors of it. Materials and methodsWe applied cardio-pulmonary exercise testing (CPET) in 104 non-severe, COPD patients. A ramp protocol was performed. Echocardiography was done before and 1−2 min after peak exercise. Cut-off values for stress induced RVDD were E/e’ >6. 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 <6. Uni- and multivariable linear regression analysis was also performed to assess the predictive power of each of them. A p-value < 0.05 was considered significant. ResultsA total of 78% of the patients had stress-induced RVDD. Right atrium volume index (RAVI) (cut-off >20.55 ml/m2; sensitivity - 86%; specificity - 86%), RV wall thickness (RVWT) (cut-off >5.25 mm; sensitivity - 100%; specificity - 63%), and RV E/A ratio at rest (cut-off >1.05; sensitivity - 79.7%; specificity - 90.5%) were the best predictors of stress RV E/e. In univariate regression analysis 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). ConclusionThere is a high prevalence of stress-induced RVDD in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. RAVI, RVWT, E/A, and E/e’ ratio at rest may be used as predictors for stress RVDD and may facilitate patients’ risk stratification and proper management.
Highlights
A renaissance in the clinical research associated with right ventricle (RV) dysfunction in chronic obstructive pulmonary disease (COPD) has been demonstrated recently
They were divided into two groups - subjects with stressinduced right ventricular diastolic dysfunction (RVDD) - 78% (82/104) (COPD-RVDD), and those without stress-induced RVDD 22% (22/104) (COPD -no RVDD)
Median Right atrium volume index (RAVI) was at the upper limit of normal 19.47 ml/m2 (21.38–23.61 ml/m2); median RV wall thickness (RVWT) – 6.5 mm (6À7 mm) with approximately 53% of subjects demonstrating evidence of RV hypertrophy
Summary
A renaissance in the clinical research associated with right ventricle (RV) dysfunction in chronic obstructive pulmonary disease (COPD) has been demonstrated recently. The aims of the current study are: 1) to detect the frequency of stress-induced RVDD in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease; and 2) to establish echocardiographic parameters at rest that may be predictors of it. Right heart structural and functional abnormalities occur even in normoxemic chronic obstructive pulmonary disease (COPD) patients. Aim: Our aim was to establish the frequency of stress-induced right ventricular diastolic dysfunction (RVDD) in non-severe COPD patients, free of overt cardiovascular disease, who complain of exertional dyspnea and to look for echocardiographic predictors of it. 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, E/A, and E/e’ ratio at rest may be used as predictors for stress RVDD and may facilitate patients’ risk stratification and proper management
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