LEFT HEART DIASTOLIC DYSFUNCTION PARAMETERS IN ASSOCIATION WITH PULMONARY FUNCTION VARIABLES IN COPD

Abstract

SESSION TITLE: Obstructive Lung Diseases 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: COPD is a leading cause for morbidity and mortality worldwide. Though it is primarily a pulmonary disease, COPD affects other body systems including the cardiovascular system. Few studies have found an association between COPD and left heart diastolic dysfunction. The aim of this study is to look for an association between parameters of diastolic dysfunction, and parameters of pulmonary function test (PFT) among patients with COPD. METHODS: This is a cross-sectional analysis performed in a community-based teaching hospital. Patients with working diagnosis of COPD, who underwent PFT during the years 2016 and 2017, were initially-screened. A total of 182 individuals were identified. We then included the patients who had; 1) forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio < 70%, and 2) an echocardiography performed not more than two years from the most recent PFT. Patients were excluded if any one of the following was identified; 1) age < 18 years old, 2) mitral stenosis, repair, or replacement, 3) moderate annular mitral valve calcification or worse, 4) moderately severe mitral regurgitation or worse, 5) left ventricular assistant device, 6) left bundle branch block, 7) ventricular-paced rhythm, 8) ejection fraction (EF) < 50%. We included the following cardiac variables; EF, tricuspid regurgitation (TR) velocity, average e/e’, septal e’, and lateral e’. PFT variables (as percentage predicted) were; post-bronchodilator FEV1, post-bronchodilator FVC, total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC). Correlation between each cardiac parameter and each PFT variable was estimated using Pearson correlation coefficient. Two-tailed t-test was used to calculate p-values. RESULTS: From the 182 initially-screened individuals, a total of 24 were identified. 66.7% (n=16) were females, and with mean age of 66.2 ± 8.2 years. After performing statistical analysis, there was a significant association between FRC and TR velocity with correlation coefficient of 0.44 (p =0.033). Moreover, there was a trend, but not a significant association, between RV and TR velocity with correlation coefficient of 0.38 (p = 0.067). CONCLUSIONS: Among patients with COPD, FRC and RV, parameters for air-trapping, are associated with TR velocity, a parameter for diastolic dysfunction. CLINICAL IMPLICATIONS: One of the theories which attempts to explain left heart diastolic dysfunction in patients with COPD is that auto-PEEP effect due to air-trapping would cause reduction in preload, which then stresses the left ventricle, leading to tachycardia with subsequent diastolic dysfunction. In our study, the association between FRC and TR velocity, along with the trend between RV and TR velocity would support this theory. This could help in predicting patients with COPD who might have unidentified left heart diastolic dysfunction. DISCLOSURES: No relevant relationships by Ali Alkhayat, source=Web Response No relevant relationships by Faeq Kukhon, source=Web Response No relevant relationships by Taro Minami, source=Web Response No relevant relationships by Ahmed Mohamed, source=Web Response No relevant relationships by Fatima Zeba, source=Web Response