High Prevalence of Left Ventricle Diastolic Dysfunction in Severe COPD Associated with A Low Exercise Capacity: A Cross-Sectional Study

Marta López-Sánchez, Mariana Muñoz-Esquerre, Daniel Huertas, José Gonzalez-Costello, Jesús Ribas, Federico Manresa, Jordi Dorca, Salud Santos, Marta López-Sánchez, Mariana Muñoz-Esquerre, Daniel Huertas, José Gonzalez-Costello, Jesús Ribas, Federico Manresa, Jordi Dorca, Salud Santos

Abstract

Background: A subclinical left ventricle diastolic dysfunction (LVDD) has been described in patients with chronic obstructive pulmonary disease (COPD).

Objectives: To evaluate the prevalence of LVDD in stable severe COPD patients, to analyze its relationship with exercise capacity and to look for its possible causes (lung hyperinflation, ventricular interdependence or inflammatory mechanisms).

Methods: We evaluated 106 consecutive outpatients with severe COPD (FEV1 between 30-50%). Thirty-three (31%) were excluded because of previous heart disease. A pulmonary function test, a 6-minute walking test (6MWT), a Doppler echocardiography test, including diastolic dysfunction parameters, and an analysis of arterial blood gases, NT-proBNP and serum inflammatory markers (CRP, leucocytes), were performed in all patients.

Results: The prevalence of LVDD in severe stable COPD patients was 90% (80% type I, n=57, and 10% type II, n=7). A significant association between a lower E/A ratio (higher LVDD type I) and a lower exercise tolerance (6-minute walked distance (6MWD)) was found (r=0.29, p<0.05). The fully adjusted multivariable linear regression model demonstrated that a lower E/A ratio, a DLCO in the quartile 4(th) and a higher tobacco consumption were associated with a lower 6MWD (76, 57 and 0.7 metres, respectively, p<0.05). A significant correlation between E/A ratio and PaO2 was observed (r=0.26, p<0.05), but not with static lung hyperinflation, inflammation or right ventricle overload parameters.

Conclusion: In stable severe COPD patients, the prevalence of LVDD is high and this condition might contribute in their lower exercise tolerance. Hypoxemia could have a concomitant role in their pathogenesis.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Patients evaluated during the study.
Figure 1. Patients evaluated during the study.
Figure 2. Individual data of the E/A…
Figure 2. Individual data of the E/A ratio as measurement of the left ventricle diastolic dysfunction (LVDD).
No significant differences were found in the E/A ratio between systemic hypertension and non-systemic hypertension patients (A). Although patients over 65 years had a significantly lower E/A ratio, younger patients also had a mean E/A ratio in the range of LVDD (B). Horizontal bars represent median values and box areas represent interquartile ranges. E/A ratio = ratio of early (E) to late (A) transmitral filling velocities.
Figure 3. Relationship between the left ventricle…
Figure 3. Relationship between the left ventricle diastolic dysfunction and the exercise tolerance in severe COPD patients.
A lower 6-minute walking distance correlated with a lower E/A ratio (A) and a lower septal e’ (B). E/A ratio = ratio of early (E) to late (A) transmitral filling velocities.

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