Left ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease - a step forward in cardiovascular comorbidome.

Zheina Cherneva,Vania Youroukova,Radostina Cherneva,Dinko Valev,Hans-Peter Brunner-La Rocca

doi:10.1371/journal.pone.0247940

Abstract

Chronic obstructive pulmonary disease (COPD) augments the likelihood of having left ventricular diastolic dysfunction (LVDD)-precursor of heart failure with preserved ejection fraction (HFpEF). LVDD shares overlapping symptomatology (cough and dyspnea) with COPD. Stress induced LVDD is indicative of masked HFpEF. Our aim was to evaluate the predictive value of inflammatory, oxidative stress, cardio-pulmonary and echocardiographic parameters at rest for the diagnosis of stress LVDD in non-severe COPD patients, who complain of exertional dyspnea and are free of overt cardiovascular diseases. A total of 104 COPD patients (26 patients with mild and 78 with moderate COPD) underwent echocardiography before cardio-pulmonary exercise testing (CPET) and 1-2 minutes after peak exercise. Patients were divided into two groups based on peak average E/e': patients with stress induced left ventricular diastolic dysfunction (LVDD)-E/e' > 15 masked HFpEF and patients without LVDD-without masked HFpEF. CPET and echocardiographic parameters at rest were measured and their predictive value for stress E/e' was analysed. Markers for inflammation (resistin, prostaglandine E2) and oxidative stress (8-isoprostanes) were also determined. Stress induced LVDD occurred in 67/104 patients (64%). Those patients showed higher VE/VCO2 slope. None of the CPET parameters was an independent predictor for stress LVDD.Except for prostglandine E2, none of the inflammatory or oxidative stress markers correlated to stress E/e'. The best independent predictors for stress LVDD (masked HFpEF) were RAVI, right ventricular parasternal diameter and RV E/A >0.75. Their combination predicted stress LVDD with the accuracy of 91.2%. There is a high prevalence of masked HFpEF in non-severe COPD with exertional dyspnea, free of overt cardiovascular disease. RAVI, right ventricular parasternal diameter and RV E/A >0.75 were the only independent clinical predictors of masked HFpEF. 288.

Highlights

Chronic obstructive pulmonary disease (COPD) patients frequently suffer from comorbidities [1]
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Our aim was to evaluate the predictive value of inflammatory, oxidative stress, cardio-pulmonary and echocardiographic parameters at rest for the diagnosis of stress left ventricular diastolic dysfunction (LVDD) in non-severe COPD patients, who complain of exertional dyspnea and are free of overt cardiovascular diseases

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) patients frequently suffer from comorbidities [1]. COPD patients have 2–3 fold elevated predisposition of cardio-vascular (CV) events even when confounders are taken into account [2]. CV comorbidity in COPD is assumed as “cardio-pulmonary continuum” rather than being attributed to shared risk factors [3]. COPD augments the likelihood of having cardio-vascular diseases (CVD), the strongest association, being with heart failure [4]. The diagnosis of heart failure with preserved ejection fraction (HFpEF) in COPD is difficult. Its precursor—abnormal left ventricular relaxation, is termed left ventricular diastolic dysfunction (LVDD). It may be present, regardless of left ventricular ejection fraction (LVEF) or patient’s symptoms [5,6]

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