Original article
Impact of Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension on Both Left Ventricular Systolic and Diastolic Performance

https://doi.org/10.1016/j.echo.2005.01.016Get rights and content

Background

The effects of chronic obstructive pulmonary disease (COPD) on right ventricular (RV) systolic and diastolic functions and left ventricular (LV) diastolic function have been shown. Whereas LV myocardial performance index (LVMPI), which incorporates ejection and isovolumic relaxation and contraction times and is an index of global ventricular function, has not yet been evaluated in COPD.

Methods

Our study population consisted of 24 age-matched control subjects (group 1), 24 patients with COPD without pulmonary hypertension (group 2), and 20 patients with COPD with pulmonary hypertension (group 3). Pulmonary function tests, analyses of arterial blood gases, and transthoracic echocardiographic examination were performed. RV myocardial performance index (RVMPI) and LVMPI were obtained by pulsed wave Doppler tissue.

Results

RVMPI was higher in both group 2 (0.61 ± 0.15) and group 3 (0.94 ± 0.27) than group 1 (0.41 ± 0.08) (P = .038 and P< .001, respectively), and was higher for group 3 than in group 2 (P = .018). LVMPI was higher for group 3 (0.77 ± 0.25) than in both group 1 (0.49 ± 0.08) and group 2 (0.59 ± 0.10) (P = .001 and P = .037, respectively). However, difference between groups 1 and 2 was not significant (P > .05). For patients with COPD, LVMPI was positively correlated with age, heart rate, pulmonary arterial systolic pressure, RVMPI, and partial pressure of carbon dioxide, and negatively correlated with tricuspid annular plane systolic excursion, forced expiratory volume in 1 second, and partial pressure of oxygen. In multiple linear regression analysis (R2 = 0.676), LVMPI was independently associated with forced expiratory volume in 1 second (Beta = 0.549, P = .017), pulmonary arterial systolic pressure (Beta = 0.488, P = .014), and RVMPI (Beta = 0.278, P = .042).

Conclusions

Both LV systolic and diastolic functions are impaired in COPD, especially in patients with pulmonary hypertension. This impairment is independently associated with pulmonary arterial systolic pressure, RVMPI, and forced expiratory volume in 1 second.

Section snippets

Participants

The study participants consisted of 24 age-matched healthy control subjects (63 ± 12 years) (group 1), 24 patients with COPD without PH (65 ± 8 years) (group 2), and 20 patients with COPD with PH (64 ± 9 years) (group 3). The control subjects had no cardiovascular or any other systems disease, and had normal physical examination, chest roentgenogram, electrocardiogram, and 2-dimensional and Doppler echocardiogram. The diagnosis of COPD was based on the criteria of the American Thoracic Society.

Clinical Characteristics of the Groups

Clinical characteristics and respiratory parameters of the study population are shown in Table 1. Age, sex, and systemic arterial blood pressures and pH did not differ among the groups. Heart rate and PASP were higher for group 3 than groups 2 and 1, and were higher for group 2 than group 1. FEV1 was lower for group 3 than groups 2 and 1, and was lower for group 2 than group 1. Partial pressure of carbon dioxide was higher, and partial pressure of oxygen was lower for group 3 than group 2.

LV Functions

Discussion

Although LV diastolic dysfunction has been shown in patients with COPD, this is the first study in the literature that evaluated LVMPI as a marker of both systolic and diastolic LV functions in this patient group. Our findings suggest the following: (1) both LV systolic and diastolic functions are impaired in the patients with COPD, especially in those with PH; and (2) these impairments are independently associated with PASP, FEV1, and RVMPI.

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