Assessment of left ventricular function in stable chronic obstructive pulmonary disease patients

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) may have left ventricular (LV) dysfunction, even in the absence of known LV diseases. Aims: The aim of this study was to assess LV function in stable COPD patients. Setting and Design: This is a cross-sectional observational analytical study. Materials and Methods: We enrolled 300 stable COPD patients without any apparent LV disease (excluded by clinical examination, chest X-ray [CXR], and electrocardiography [ECG]). The control group consisted of 100 age- and sex-matched healthy subjects. LV systolic function was assessed using echocardiography by measuring shortening fraction (FS%), LV ejection fraction (EF%), and the mitral valve peak annular velocity at the LV lateral wall (Sm). LV diastolic function was assessed by (i) ratio between early rapid filling phage and late rapid filling phage, (ii) deceleration time, and (iii) isovolumetric relaxation time. Statistical Analysis: The statistical calculations were done with the use of the statistical software SPSS 19. We analyzed the association of LV diastolic dysfunction with the variables (age, CXR, Global Initiative for Chronic Obstructive Lung disease [GOLD] staging, ECG, dyspnea, and duration of illness) of COPD patients by Chi-square test and the test of significance was defined by P value <0.05. Results: Most patients were in GOLD stages II and III (44 and 30%, respectively). ECG was abnormal (like p-pulmonale, low-voltage complex, right bundle branch block, etc.) in 92.30% of patients. LV diastolic dysfunction was demonstrated in 84% of patients who were mostly in GOLD stages II and III with duration of illness ≥5 years and had ECG and CXR abnormalities. Isolated systolic dysfunction was not observed. We found a statistically significant association between the prevalence of LV diastolic dysfunction with the patients’ age, duration of illness, GOLD staging, ECG, and CXR findings (P < 0.001). Conclusions: LV dysfunction should be considered as a cause when COPD patients do not respond to the standard treatment protocol.

Keywords

• chest x-ray
• chronic obstructive pulmonary disease
• diastolic dysfunction
• electrocardiography
• gold stage
• left ventricular