Echocardiography in assessment of left ventricular diastolic dysfunction in patients with pulmonary arterial hypertension

 

 

Abstract              Background: Chronic obstructive pulmonary disease is a leading cause of morbidity and mortality in adults all over the world. While other major causes of non-cancer mortality such as coronary artery disease and stroke have shown a consistent downward trend, COPD is the only one that continues to increase. Amis and objectives: To study Echocardiographic assessment of left ventricular diastolic dysfunction in patients with pulmonary arterial hypertension Materials and method: The present study was conducted in the department of Cardiology at Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar for the two year duration. Thirty five consecutive patients of any age with different severity of pulmonary arterial hypertension due to chronic obstructive airway disease (emphysema and chronic bronchitis) constituted the study group (Group-I) and were labeled as "cases". Pulmonary arterial hypertension was diagnosed in them as presence of right ventricular systolic pressure of more than or equal to 40mmHg. Results: Patients with pulmonary arterial hypertension had similar aortic and left atrial dimensions as the control group. Left ventricular internal diameters, particularly the systolic diameter, were decreased in patients with pulmonary hypertension than corresponding dimensions in healthy volunteers. Similarly, left ventricular end-diastolic and end-systolic volumes were significantly reduced in cases as compared to the control group. Left ventricular ejection fraction and fractional shortening were both significantly higher in patients with pulmonary hypertension as compared to the controls. Left ventricular posterior wall and interventricular septum were similar in thickness in both the groups. However, the interventricular septal motion was paradoxical in 15 (42%) of cases and was normal in controls. Right ventricular dimensions were significantly higher in the pulmonary hypertension group as compared to the controls (p=0.000). Conclusion: Thus we conclude that patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease have reduced left ventricular internal dimension and that this reduction bears a relation with the level of respiratory compromise and with the severity of pulmonary hypertension. However, left ventricular systolic function is well preserved in these patients irrespective of the severity of lung disease. On the other hand, left ventricular diastolic function is abnormal in patients with pulmonary hypertension as compared to normal age- and sex-matched control population.

Key Word: Echocardiography, left ventricular diastolic dysfunction, pulmonary arterial hypertension