Evaluation of Left Ventricular Function, Contractility and Ejection Fraction in COPD Patients by Echocardiography

Abstract

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. According to global initiative for chronic obstructive lung disease, COPD is defined as FEV1/FVC<70% by spirometry. COPD affects pulmonary blood vessels, right ventricle as well as left ventricle, leading to development of pulmonary hypertension, cor-pulmonale, right ventricular dysfunction as well as left ventricular dysfunction. The significance of the right ventricular performance is recognized as one of the factors determining the clinical course and prognosis in COPD, but a potential role of the left ventricle is, however, less studied. The aim of this study was primarily to evaluate left ventricular function in COPD patients by echocardiography and to study the correlation between echocardiography findings and the severity of COPD based on GOLD1 criteria. A total of 100 patients were selected for this study, including 72 male patients and 28 female patients, aged 50–70 years, from outpatient department of medicine department, medical wards, TB and chest ward of Dr Baba Sahib Ambedkar Hospital, Delhi, considering the exclusion and inclusion criteria. In mild COPD group, only one patient was found to have systolic dysfunction out of 52 patients (1.92%), in moderate COPD group, 2 patients had systolic dysfunction out of 32 patients (6.25%), whereas in severe COPD, six patients had systolic dysfunction out of 16 patients (37.5%). So, in total, 9% patients had systolic dysfunction. 28% of patients were found to have left ventricular diastolic dysfunction in our study. COPD patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. A clear correlation was found between value of fractional shortening (FS) of left ventricle (a measure of contractility), and severity of COPD and FS value significantly decreased as the severity of COPD increased. In this study, ejection fraction (EF) was found to be preserved in mild and moderate COPD, albeit mean EF was found to be reduced in moderate COPD. In severe COPD group, EF was significantly lowered.