Abstract
BackgroundPulmonary pulse wave velocity (PWV) allows the non-invasive measurement of pulmonary arterial stiffening, but has not previously been assessed in COPD. The aim of the current study was to assess PWV in COPD and its association with right ventricular (RV) remodelling.MethodsFifty-eight participants with COPD underwent pulmonary function tests, 6-min walk test and cardiac MRI, while 21 healthy controls (HCs) underwent cardiac MRI. Thirty-two COPD patients underwent a follow-up MRI to assess for longitudinal changes in RV metrics. Cardiac MRI was used to quantify RV mass, volumes and PWV. Differences in continuous variables between the COPD and HC groups was tested using an independent t-test, and associations between PWV and right ventricular parameters was examined using Pearson’s correlation coefficient.ResultsThose with COPD had reduced pulsatility (COPD (mean±SD):24.88±8.84% vs. HC:30.55±11.28%, p=0.021), pulmonary acceleration time (COPD:104.0±22.9ms vs. HC: 128.1±32.2ms, p<0.001), higher PWV (COPD:2.62±1.29ms-1 vs. HC:1.78±0.72ms-1, p=0.001), lower RV end diastolic volume (COPD:53.6±11.1ml vs. HC:59.9±13.0ml, p=0.037) and RV stroke volume (COPD:31.9±6.9ml/m2 vs. HC:37.1±6.2ml/m2, p=0.003) with no difference in mass (p=0.53). PWV was not associated with right ventricular parameters.ConclusionsWhile pulmonary vascular remodelling is present in COPD, cardiac remodelling favours reduced filling rather than increased afterload. Treatment of obstructive lung disease may have greater effect on cardiac function than treatment of pulmonary vascular disease in most COPD patientsKey Points• Pulmonary pulse wave velocity (PWV) is elevated in COPD.• Pulmonary PWV is not associated with right ventricular remodelling.• Right ventricular remodelling is more in keeping with that of reduced filling.
Highlights
COPD is the second most common cause of pulmonary hypertension after left-sided heart disease, with the prevalence of this increasing with increasing severity of COPD [1]
Pulmonary pulse wave velocity (PWV) is not associated with right ventricular remodelling
Inclusion criteria for the study were a diagnosis of COPD, based on the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines of post-bronchodilator forced expiratory volume in 1 s (FEV1)/ forced vital capacity (FVC)
Summary
COPD is the second most common cause of pulmonary hypertension after left-sided heart disease, with the prevalence of this increasing with increasing severity of COPD [1]. Pulmonary arterial wall thickness is related to exercise pulmonary pressures rather than resting pulmonary pressures, and correlates highly with change in pressure from rest to exercise [7]. This fits well with observations in idiopathic pulmonary hypertension where a curvilinear relationship exists between RV function and PA distensibility. The aim of the current study was to assess PWV in COPD and its association with right ventricular (RV) remodelling. Differences in continuous variables between the COPD and HC groups was tested using an independent t-test, and associations between PWV and right ventricular parameters was examined using Pearson’s correlation coefficient
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