Assessment of RV Function in Patients of (COPD)

Assessment of the right ventricular strain, left ventricular strain and left atrial strain using speckle tracking echocardiography in patients with chronic obstructive pulmonary disease

OBJECTIVES

Cardiovascular disease is a prevalent comorbidity and leading cause of mortality in chronic obstructive pulmonary disease (COPD) patients. Early identification of cardiac abnormalities in COPD patients is crucial. Speckle tracking echocardiography (STE) is practical for assessing ventricular and atrial function, but its role in COPD patients is under-researched. This study aimed to examine right ventricular (RV), left ventricular (LV) and left atrial (LA) strain in COPD patients via STE.

METHODS

A cross-sectional study was conducted with two groups: COPD patients diagnosed per the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria and healthy controls. All the participants underwent STE to evaluate the RV, LV, and LA strains.

RESULTS

RV strain indices (RV free wall longitudinal strain (RVFWSL) and RV 4-chamber longitudinal strain (RV4CSL)) were significantly lower in the COPD group (16.53±5.89% and 14.65±4.53%, respectively) than in the control group (21.39±7.78% and 18.34±6.38%, respectively) (p<0.001). LV global longitudinal strain was also lower in the COPD group (18.45% (17.16-19.51)) than in the control group (19.50% (18.63-21.46), p=0.018). No significant differences were found in LA strain indices (LA reservoir strain, LA conduit strain or LA contractile strain) between the two groups. Furthermore, RVFWSL and RV4CSL were significantly greater in the group with a modified Medical Research Council score <2 (p<0.05).

CONCLUSION

Compared with healthy controls, COPD patients presented reduced RV and LV strain, with no significant differences in LA strain indices.

Assessment of Cardiac Dysfunction in Patients With Chronic Obstructive Pulmonary Disease (COPD): A Cross-Sectional Study

BACKGROUND

 Cardiovascular diseases (CVDs) are frequent in patients having chronic obstructive pulmonary disease (COPD). Despite that, comorbid CVDs receive less guideline-recommended screening in this population compared to others. We aimed to evaluate the cardiac function using echocardiography and to assess spirometry, arterial blood gas (ABG) as well as brain natriuretic peptide (BNP) as prognostic indicators of cardiovascular dysfunction in COPD patients.

METHODS

One hundred moderate to very severe COPD patients according to GOLD guidelines with no history of cardiac diseases were recruited from two hospitals in Saudi Arabia and evaluated using electrocardiography (ECG), chest X-ray, BNP, pulmonary functions, ABG analysis, and transthoracic echocardiography. Multiple linear regression analysis was used to determine the predictors of right ventricular (RV) and left ventricular (LV) dysfunction.

RESULTS

Pulmonary hypertension (PH) was detected in 28% of the patients, while 25% had abnormal tricuspid annular plane systolic excursion (TAPSE). Low left ventricular ejection fraction (LVEF) and abnormal LV strain were present in 20%, abnormal right ventricular strain was present in 17%, and abnormal fractional area change (FAC) was detected in 9% of patients. Multiple linear regression analysis was used to explore possible determinants of cardiac function. Age, gender, and the presence of diabetes and hyperlipidemia were significant predictors of cardiac dysfunction in COPD patients. Forced vital capacity (FVC) was an independent predictor of LVEF (odds ratio, OR: 0.424, confidence interval, 95 CI%: 0.025-0.505, p<0.031) and FAC (OR: 0.496, 95 CI%: 0.008-655). Hypoxemia and hypercapnia significantly predict both RV and LV dysfunctions. BNP was an independent predictor of FAC (OR: 0.307, 95 CI%: -0.021, p<0.001).

CONCLUSION

Cardiac abnormalities are common in moderate to very severe COPD patients. Echocardiography could be considered for the assessment of these patients even in the absence of a history of cardiac disease. Pulmonary functions, ABG, and BNP may offer additional predictive information on cardiac functions in COPD patients.