Systolic function of the left ventricle in patients with pulmonary hypertension on the background of chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) greatly affects the quality of life, significantly limiting the physical capabilities of people suffering from it. The prevalence of COPD worldwide is about 7,6 %, and it is one of the main causes of morbidity and mortality in today’s society. An urgent medical and social problem of our time is the development of pulmonary hypertension (PH) in patients with COPD. Transthoracic echocardiography is important for PH screening. It has the highest sensitivity and specificity among non-invasive examinations, and unlike catheterization of the right heart, it does not require special equipment and centers for dynamic monitoring of patients with PH. When pulmonary hypertension, there is a pronounced remodeling of the heart. At the first stage, it occurs in the right parts of the heart, and in the future, as a consequence, it is accompanied by a violation of systolic inter-ventricular interactions.
Purpose of the study. To determine the characteristics of left ventricular systolic function in patients with pulmonary hypertension on the background of COPD.
Materials and methods. Results of the study are based on data from a comprehensive survey of 170 COPD patients aged 40 to 65 years, 123 of which had pulmonary hypertension and 47 ones had no pulmonary hypertension.
Results and discussion. In the group of patients with PH on the background of COPD, the shock volume was 74,72 cm3 (64,60–83,09) and it was significantly lower compared to the level of 82,04 cm3 (75,20–87,76) of the COPD group without PH (p < 0,05). Such echocardiographic index as left ventricular ejection fraction in groups of patients with COPD with PH and without it, was 57,59% (53,84–62,19) and 59,44% (56,67–61,88), respectively, and it was significantly lower compared to the level of 64,62% (62,86–67,91) of healthy individuals (p < 0,05).
There was a straight increase in end-diastolic volume and end-systolic volume in the subgroup of patients with COPD duration > 12 years compared to the subgroup 12 years, 134,17 cm3 (117,00–150,15) versus 125,52 cm3 (105,20–139,60) and 57,37 cm3 (51,70–65,60) versus 51,40 cm3 (43,08–59,84),
respectively (p < 0,05). The impact volume had no significant differences between subgroups depending on the duration of COPD (p > 0,05). The level of LV ejection fraction was significantly lower in the subgroup of COPD duration > 12 years 56,64% (52,65–59,73) against the subgroup 12 years (p < 0,05). There were no significant differences between the levels of systolic heart function indicators: end-diastolic volume, end-systolic volume, shock volume, and LV EF depending on the stage of COPD (p > 0,05). Correlation analysis revealed significant relationships between the following indicators: duration of COPD and ESV (R = +0,24, p = 0,008); duration of COPD and LV EF (R = –0,25, p = 0,006); MPAP and EDV (R = –0,22, p = 0.02); MPAP and SV (R = –0,26, p = 0,004); MPAP and LV EF (R = –0,21, p = 0,02).
Dury R. COPD and emotional distress: not always noticed and therefore untreated. British journal of community nursing. 2016; 21 (3): 138–141. DOI: 10.12968/bjcn.2016.21.3.138.
Rodriguez-Roisin R, Rabe KF, Vestbo J et al. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 20th anniversary: a brief history of time. European Respiratory Journal. 2017; 50: 1–6. DOI: 10.1183/13993003.00671-2017.
López-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology. 2016; 21 (1): 14–23. DOI: 10.1111/resp.12660.
Tanabe N, Taniguchi H, Tsujino I et al. Multi-institutional retrospective cohort study of patients with severe pulmonary hypertension associated with respiratory diseases. Respirology. 2015; 20 (5): 805–812. DOI: 10.1111/resp.12530.
Sirenko YM, Zhyvylo IO, Radchenko HD. Creating a state registry of patients with pulmonary hypertension – a requirement of the present?. Ukrainskyi kardiolohichnyi zhurnal. 2016; 1: 41–46.
D'Alto M, Romeo E, Argiento P et al. Pulmonary arterial hypertension: the key role of echocardiography. Echocardiography. 2015; Suppl 1: S23–37. DOI: 10.1111/echo.12283.
Bossone E, Ferrara F, Grünig E. Echocardiography in pulmonary hypertension. Current opinion in cardiology. 2015; 30 (6): 574–586. DOI: 10.1097/hco.0000000000000217.
Barberà JA. Pulmonary hypertension in COPD: new insights. Monografías de Archivos de Bronconeumología. 2015; 2 (3): 53–54. DOI: 10.1183/09031936.03.00115402.
Lang RM, Badano LP, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal-Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28 (1):1–39.e14. DOI: 10.1016/j.echo.2014.10.003.
Rossi A, Aisanov Z, Avdeev S. Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD. Respiratory medicine. 2015; 109 (7): 785–802. DOI: 10.1016/j.rmed.2015.03.010.
Ghosh I, Chakraborty A, Mahapatra ABS. Echocardiographic evaluation of right ventricle in different stages of chronic obstructive pulmonary disease (COPD) and its correlation with severity of the disease. World Journal of Pharmaceutical Research. 2017; 6 (14): 632–643.
Hardegree EL, Sachdev A, Fenstad ER. Impaired left ventricular mechanics in pulmonary arterial hypertension: identification of a cohort at high risk. Circulation: Heart Failure. 2013; 6 (4): 748–755. DOI: 10.1161/CIRCHEARTFAILURE.112.000098.
Gan C, Lankhaar JW, Marcus JT et al. Impaired left ventricular filling due to rightto-left ventricular interaction in patients with pulmonary arterial hypertension. American Journal of Physiology-Heart and Circulatory Physiology. 2006; 290 (4): Н1528–1533. DOI: 10.1152/ajpheart.01031.2005.
El Wahsh RA, Ahmed MK, Yaseen RI. Evaluation of left ventricular function in patients with chronic obstructive pulmonary disease with or without pulmonary hypertension. Egyptian Journal of Chest Diseases and Tuberculosis. 2013; 62 (4): 575–582. DOI: 10.1016/j.ejcdt.2013.08.004.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.