Cardiovascular Performance in Chronic Obstructive Pulmonary Diseases

Right Ventricular Performance during Exercise in Chronic Obstructive Pulmonary Disease

“…The present study confirms our earlier observations [11] and those of others [19] that when measured at rest RVEF is lower, but LVEF is similar in patients with COPD, as compared to normal subjects. However, RVEF remains relatively well preserved in such patients, unless they de velop the clinical syndrome of cor pulmo nale associated with peripheral oedema [11].…”

“…In this study, as in others [19], occult right ventricular dysfunction can be dem onstrated during exercise in patients with COPD. This has been presumed to result from an augmented right ventricular after load in such patients during exercise [19], However, this study shows that the re sponse of the RVEF to exercise in patients with COPD is related to the degree of oxy gen desaturation which occurs during the exercise.…”

“…The fall in RVEF during exercise may, as suggested by others [19], have been due to an increase in PAP on exercise which would have been partially reversed by oxygen. However, the reduction in the level of PAP on exercise in patients with COPD produced by breathing oxygen, even when given in high concentrations, is small [20].…”

Right Ventricular Function in Cor pulmonale

“…Whereas the clinical syn drome of cor pulmonale, or pulmonary heart disease, consists of peripheral oedema in association with raised jugular venous pressure, together with clinical, radiographic or electrocardiographic evidence of right ventricular hypertrophy [2,3], Pa tients with cor pulmonale often do not have signs of right ventricular hypertrophy [4] and the literature is divided as to whether the presence of right ventricular hypertro phy on the ECG correlates with post-mor tem evidence of hypertrophy [5,6].…”

“…In the UK, chronic obstructive pulmonary disease (COPD) is the commonest cause of cor pul monale. Twenty years ago 40% of patients with chronic bronchitis and emphysema who had an autopsy showed pathological evi dence of cor pulmonale [7], Chronic hypoxaemia which develops in some patients with COPD leads to hypoxic pulmonary vasocon striction and later structural changes in the pulmonary vasculature which contribute to the development of pulmonary arterial hy pertension, initially occurring only during exercise, but later at rest [2][3][4], However, the pulmonary arterial pressure (Ppa) in patients with COPD seldom approaches the systemic values seen in primary pulmonary hyperten sion, a much rarer cause of cor pulmonale [8]. Pulmonary hypertension progresses slowly in patients with hypoxic COPD.…”