Echocardiographic and Hemodynamic Assessment of Right Heart Impairment in Chronic Obstructive Lung Disease

L, Bertoli; Rizzato, G; Sala, G; Merlini, R.; Cicero, Salvatore Lo; Pezzano, Antonio

doi:10.1159/000194559

Cited by 13 publications

(2 citation statements)

References 9 publications

(11 reference statements)

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“…Finally, the RV/(LVϩS) ratio was also significantly increased in both PHT groups. All these parameters were more altered in the monocrotaline PHT group than in the hypoxic PHT group (Tables 1 and 2), indicating a severe PHT in rats treated with monocrotaline (5, 30, 32) compared with a moderate PHT following chronic hypoxia exposure (16), as previously observed in some invasive studies (2,16,17).…”

Section: Discussionsupporting

confidence: 73%

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Boissière¹,

Gautier²,

Machet³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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-We aimed to assess the accuracy of Doppler tissue imaging (DTI) in detecting right ventricle (RV) dysfunction and electromechanical coupling alteration following pulmonary hypertension (PHT) in rat. PHT was induced by chronic hypoxia exposure (hypoxic PHT) or monocrotaline treatment (monocrotaline PHT). In both PHT models, we observed transparietal RV pressure increase and remodeling, including hypertrophy and dilation. Conventional echocardiography provided evidence for pulmonary outflow impairment with midsystolic notch and acceleration time decrease in PHT groups (21.7 Ϯ 1.6 and 13.2 Ϯ 2.9 ms in hypoxic and monocrotaline PHT groups vs. 28.1 Ϯ 1.0 ms in control). RV shortening fraction was decreased in the monocrotaline PHT group compared with the hypoxic PHT and control groups. Combining conventional Doppler and DTI was more helpful to detect RV diastolic dysfunction in the monocrotaline PHT group (E/Ea ratio ϭ 17.0 Ϯ 1.4) compared with the hypoxic PHT and control groups (11.5 Ϯ 0.7 and 10.2 Ϯ 0.4, respectively). Tei index measured using DTI highlighted global RV dysfunction in the monocrotaline PHT group (1.36 Ϯ 0.24 vs. 0.92 Ϯ 0.05 and 0.86 Ϯ 0.05 in the hypoxic PHT and control groups, respectively). Q-S m time measured from the onset of Q wave to the onset of DTI S m wave was increased in both PHT groups. PHT-induced electromechanical coupling alteration was confirmed by in vitro activation-contraction delay measurements on isolated RV papillary muscle, and both Q-S m time and activation-contraction delay were correlated with PHT severity. We demonstrated that Q-Sm time measured in DTI was an easily and convenient index to detect early RV electromechanical coupling alteration in both moderate and severe PHT. echocardiography; hypertrophy; right ventricular remodeling CHRONIC ALVEOLAR HYPOXIA, which often occurs in patients suffering from chronic obstructive pulmonary diseases, secondarily induces a sustained increase in pulmonary artery resistance. The subsequent pulmonary artery hypertension (PHT) leads to right ventricle (RV) pressure overload and hypertrophy (22).Conventional transthoracic echocardiography is widely used to detect PHT in humans and animal models (14, 18). The standard parameters are the RV free wall thickening recorded in time-motion (TM) mode, the presence of mild-systolic notch, and the acceleration time decrease in the pulmonary outflow spectrum recorded in pulsed-Doppler mode. Nevertheless, a more extensive assessment of PHT-induced RV dysfunction remains difficult using conventional echocardiography. Indeed, accuracy of RV systolic and diastolic functions assessment is limited by complex anatomy and geometry of the ventricle.The Tei index, which combines both systolic and diastolic parameters, was suggested to determine global myocardial performance (27). It has been used in the assessment of RV dysfunction, especially in PHT (26). In conventional pulsed Doppler, the Tei index derives from both isovolumic contraction and relaxation times (IVCT and IVRT) as well as ejection time of...

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Section: Discussionsupporting

confidence: 73%

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Boissière¹,

Gautier²,

Machet³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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“…Chronic corpulmonale is usually the end result of long standing pulmonary disease, which results from pulmonary hypertension and subsequently right ventricular hypertrophy and failure. 3 Once developed the patient with corpulmonale has poor prognosis. Since the electrocardiogram is a very simple and convenient bedside investigation, it would be of great importance, if it can be established that a high degree of correlation between ECG and different grades of disease is present which indicate the severity of COPD.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease and its correlation with disease severity

et al. 2017

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Background: Chronic obstructive pulmonary disease is the fourth leading cause of mortality worldwide. It is defined as a disease state characterized by airflow limitation that is not fully reversible. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease. Electrocardiography (ECG) carries information about cardiac disease and prognosis in COPD patients. Present study was undertaken to correlate ECG changes with severity of COPD.Methods: 100 patients of COPD fulfilling the inclusion criteria coming to OPD/wards of NMCH, Kota were recruited. They were staged by pulmonary function test (PFT) and evaluated by electrocardiography. Statistical analysis of correlation was done with chi square test and statistical significance was taken p<0.05.Results: Mean age was 63.18±8.66 years, with male preponderance, male to female ratio 6.14:1. Mean duration of disease was 7.58±2.92 years, mean exposure to smoking of 25.06 pack years. Most common ECG finding was RAD which was present in 69% of cases, other ECG findings are P. pulmonale (45%), incomplete RBBB (15%), PPRW (35%), RVH (53%). All ECG findings except incomplete RBBB significantly correlated with disease severity (‘p’ value <0.05).Conclusions: COPD is more common in male in 5th to 7th decade of life, with a smoking history of more than 20 pack years. The occurrence of ECG findings increase as severity and duration of disease increase. It can be inferred that ECG is a useful bedside test to assess the severity of COPD.

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Noninvasive Assessment of Pulmonary Arterial Pressure with Ultrasound

Tramarin

Torbicki

Forni

et al. 1993

Current Topics in Rehabilitation

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Echocardiographic and Hemodynamic Assessment of Right Heart Impairment in Chronic Obstructive Lung Disease

Cited by 13 publications

References 9 publications

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Doppler tissue imaging in assessment of pulmonary hypertension-induced right ventricle dysfunction

Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease and its correlation with disease severity

Noninvasive Assessment of Pulmonary Arterial Pressure with Ultrasound

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