Left ventricular functions in patients with pulmonary arterial hypertension due to chronic obstructive pulmonary disease

 

 

Abstract              Background: Pulmonary hypertension is a frequent complication in the natural history of chronic obstructive pulmonary disease (COPD). Its presence is associated with shorter survival rates and it has been identified as a predictive factor of worse clinical outcomes and frequent use of health resources. Amis and objectives: To study the Left Ventricular Functions in Patients with Pulmonary Arterial Hypertension Due to Chronic Obstructive Pulmonary Disease. 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 labelled as "cases". Pulmonary arterial hypertension was diagnosed in them as presence of right ventricular systolic pressure of more than or equal to 40mmHg. Thirty five normal subjects who were matched for age and sex constituted the other group (Group-II or "controls"). The patients in our study were clinically stable and medications such as inhaled steroids, (3-2 agonists and the ophylline were continued. All patients and controls were made to undergo two-dimensional and M-mode echocardiography and Doppler examinations by a cardiologist who was blinded to the group status of the individual subjects. Results: The demographic characteristics of the cases and controls were comparable. The control population was largely free of any significant symptoms or abnormal clinical findings. On systemic examination it was observed that TR was the most common finding in cases followed by was Palpable RVI and Wheeze in Chest. While on control group on systemic examination Wheeze in Chest and Hepatomegaly was observed in 5.7% and 2.8% patients only. Echocardiographic assessment results showed that our cases and controls had similar aortic and left atrial dimensions. 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. Doppler/echocardiographic assessment of left ventricular diastolic functions revealed that E/A ratio was significantly lower in cases than controls (0.86±0.35 vs 1.34± 0.30, respectively, p=0.000). Conclusion: Thus the present study has demonstrated 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.

Key Word: Left Ventricular Functions, Pulmonary Arterial Hypertension, COPD.