Pulmonary hemodynamics and remodeling of the right heart in patients with COPD depending on the risk group, the direction of drug correction

Abstract

Objective : to assess pulmonary hemodynamics and the presence of systolic and/or diastolic dysfunction of the myocardium of the right and left ventricles in patients with COPD, depending on the risk groups (A, B, C, D); to determine the possible directions of pharmacological correction. Methods. Patients (n = 119, including 87 men, mean age - 62.5 ± 14.8 years) with COPD of risk group A (n = 21) and B (n = 98) (GOLD, 2019). In addition to the routine clinical and instrumental examinations, pulmonary and aortic pulse wave velocity was determined using MRI diagnostics. Results. The right ventricular diastolic dysfunctions (DD) were revealed in all patients with COPD (E/A TV = 0.85 ± 0,03 vs 0.97 ± 0,03; groups A and B respectively, p < 0,05). 28.6% of patients of group B had a restrictive type of transtricuspid blood flow (p < 0,05). The pulmonary blood pressure was increased: 24.3 ± 7.6 mm Hg in patients with COPD group A, 17.2 ± 6.8 mm Hg - in group B. Patients of group B had a higher pulmonary pulse wave velocity (pPWV) (B: 3.13 [2.93-3.44] ms-1 vs A: 1.97 [1.62-2.68] ms-1, p = 0.005) and stroke volume of RV (B: 33.5 [27.3-37.9] mL vs A: 29.1 [24.0-35.7] mL, p = 0.005). The correlation between pPWV and the degree of bronchial obstruction, ejection fraction and end-diastolic volume of the RV, and mean pulmonary arterial pressure (mPAP) was strong for patients of group B and moderate for patients of group A. Conclusion. Thus, patients with COPD risk group A have the borderline indicators of mPAP with DD of LV and RV. The progression of hemodynamic disorders is associated with the aggravation of of clinical symptoms and respiratory disorders, that were more pronounced in group B. This progression led to mandatory broncholytic drug correction.