Abstract
BackgroundA subclinical left ventricle diastolic dysfunction (LVDD) has been described in patients with chronic obstructive pulmonary disease (COPD).ObjectivesTo evaluate the prevalence of LVDD in stable severe COPD patients, to analyze its relationship with exercise capacity and to look for its possible causes (lung hyperinflation, ventricular interdependence or inflammatory mechanisms).MethodsWe evaluated 106 consecutive outpatients with severe COPD (FEV1 between 30–50%). Thirty-three (31%) were excluded because of previous heart disease. A pulmonary function test, a 6-minute walking test (6MWT), a Doppler echocardiography test, including diastolic dysfunction parameters, and an analysis of arterial blood gases, NT-proBNP and serum inflammatory markers (CRP, leucocytes), were performed in all patients.ResultsThe prevalence of LVDD in severe stable COPD patients was 90% (80% type I, n=57, and 10% type II, n=7). A significant association between a lower E/A ratio (higher LVDD type I) and a lower exercise tolerance (6-minute walked distance (6MWD)) was found (r=0.29, p<0.05). The fully adjusted multivariable linear regression model demonstrated that a lower E/A ratio, a DLCO in the quartile 4th and a higher tobacco consumption were associated with a lower 6MWD (76, 57 and 0.7 metres, respectively, p<0.05). A significant correlation between E/A ratio and PaO2 was observed (r=0.26, p<0.05), but not with static lung hyperinflation, inflammation or right ventricle overload parameters.ConclusionIn stable severe COPD patients, the prevalence of LVDD is high and this condition might contribute in their lower exercise tolerance. Hypoxemia could have a concomitant role in their pathogenesis.
Highlights
Chronic obstructive pulmonary disease (COPD) is associated with relevant extrapulmonary effects and comorbidities that may influence the course of the disease [1]
In a previous study conducted in elderly chronic obstructive pulmonary disease (COPD) patients, the prevalence of unrecognized heart failure was over 20%, and isolated diastolic heart failure was involved in half of these cases [7]
The main finding of our study was the high prevalence of left ventricle diastolic dysfunction (LVDD) (90%) in severe stable COPD patients
Summary
Chronic obstructive pulmonary disease (COPD) is associated with relevant extrapulmonary effects and comorbidities that may influence the course of the disease [1]. COPD is considered an independent cardiovascular risk factor [2,3] and ischemic heart disease is one of the main causes of mortality in COPD [4]. Coexistence of both diseases is very common and has diagnostic, therapeutic and prognostic implications [5,6]. Objectives: To evaluate the prevalence of LVDD in stable severe COPD patients, to analyze its relationship with exercise capacity and to look for its possible causes (lung hyperinflation, ventricular interdependence or inflammatory mechanisms). A significant association between a lower E/A ratio (higher LVDD type I) and a lower exercise tolerance (6minute walked distance (6MWD)) was found (r=0.29, p
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