Atrial electromechanical delay, neutrophil-to-lymphocyte ratio, and echocardiographic changes in patients with acute and stable chronic obstructive pulmonary disease

Abstract

Background: Atrial electromechanical delay (AEMD) is the time interval between the beginning of P wave on surface electrocardiography and starting of the late diastolic wave on tissue Doppler imaging. We investigated the prolongation of AEMD, echocardiographic changes, and correlation of these findings with neutrophil-to-lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods: The study consisted of 105 (49 females and 56 males; mean age: 65.1 ± 9) patients with COPD exacerbation and 104 (21 females and 83 males; mean age: 64.8 ± 9.6) stable COPD outpatients. Demographics, body mass index, pulmonary function tests, and transthoracic echocardiography of the patients were evaluated. Echocardiography was performed in the first 6 h for stable COPD outpatients and in the first 24 h for COPD exacerbation patients. Diameters of right ventricle (RV), left ventricle (LV) and left atrium, aortic root diameters, left ventricular ejection fraction (LVEF), E max , A max , E max /A max , tricuspid annular plane systolic excursion (TAPSE), Ea, Aa, Ea/Aa, E max /Ea, and tricuspid regurgitation velocity (TRV) were evaluated. AEMD measurements were obtained from lateral/tricuspid, lateral/mitral, and septal annulus from apical four-chamber views with tissue Doppler imaging and corrected for heart rate. Complete blood count including NLR was also assessed. Results: The mean age of patients in exacerbation period (65.1 ± 9) was higher than the stable group (64.8 ± 9.6). RV basal and mid diameters ( P < 0.001), A max ( P < 0.001), Ea tricuspid ( P = 0.040), Aa tricuspid ( P < 0.001), TRV, and systolic pulmonary artery pressure ( P < 0.001) were higher; TAPSE and tricuspid E max /A max ( P < 0.001) were significantly lower in patients with COPD exacerbation. LV end-diastolic diameter ( P = 0.002) and LVEF ( P = 0.005), E max /A max mitral ( P < 0.001), Ea/Aa mitral ( P < 0.001), and Ea/Aa septal ( P < 0.001) were significantly lower; A max mitral ( P = 0.002), Aa mitral ( P < 0.001), Aa septal ( P < 0.001), and systolic motion mitral ( P = 0.011) were significantly higher in patients with exacerbation. AEMD lateral/tricuspid ( P < 0.001), lateral/mitral ( ...