High Prevalence of Left Ventricle Diastolic Dysfunction in Severe COPD Associated with A Low Exercise Capacity: A Cross-Sectional Study

López-Sánchez, Maite; Muñoz-Esquerre, Mariana; Huertas, Daniel; González‐Costello, José; Ribas, J.; Manresa, F.; Dorca, Jordi; Santos, Salud

doi:10.1371/journal.pone.0068034

Cited by 56 publications

(42 citation statements)

References 38 publications

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“…19 Although it was present in 57% of our cohort, LVDD did not have a significant bivariate association with 6MWT distance in our cohort. This finding may be explained by the fact that 93% of individuals with LVDD in our cohort had only Stage I LVDD, an early form of diastolic impairment state that is not typically associated with functional limitation.…”

Section: Discussioncontrasting

confidence: 60%

Right ventricular diastolic function and exercise capacity in COPD

Fenster

Holm

Weinberger

et al. 2015

Respiratory Medicine

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Background Decreased exercise capacity in chronic obstructive pulmonary disease (COPD) is incompletely explained by pulmonary pathologic and physiologic abnormalities. We evaluated the extent to which right ventricular diastolic function (RVDF) is associated with exercise capacity in COPD. Methods Fifty-one patients with COPD were evaluated by echocardiography, spirometry, and the 6 minute walk test (6MWT). RVDF was assessed using 4 echocardiographic parameters: 1) the ratio of tricuspid valve (TV) early (E) and late (A) inflow velocities (TV E/A) 2) TV early tissue Doppler velocity (TV e’) 3) TV deceleration time (DT) and 4) the ratio of TV E and e’ velocities (TV E/e’). Multiple linear regression was used to examine the extent to which these parameters were associated with 6MWT distance. All models adjusted for age, sex, post-bronchodilator FEV1/FVC, resting heart rate, and use of supplemental O2 during 6MWT. A regression model was calculated for each of the 4 markers of RVDF. Results Forty-seven percent of the sample had GOLD stage III or IV COPD. All 51 subjects had preserved left ventricular ejection fraction (LVEF, mean = 71.7%, SD = 7.8%). A higher TV E/A ratio was associated with increased 6MWT distance (p = 0.001). TV e’, TV DT and TV E/e’ did not have a statistically significant association with 6MWT distance in regression models. Conclusions In a cohort with moderate to severe COPD and normal LVEF, TV E/A was associated with 6MWT distance after adjusting for relevant demographic and medical covariates. RV diastolic dysfunction may independently contribute to exercise intolerance in COPD.

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Section: Discussioncontrasting

confidence: 60%

Right ventricular diastolic function and exercise capacity in COPD

Fenster

Holm

Weinberger

et al. 2015

Respiratory Medicine

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“…One case series of 38 patients with pulmonary hypertension from different etiologies revealed Cheyne-Stokes respiration in 39% of the patients. 145 Similarly, COPD is frequently associated with left ventricle diastolic dysfunction 146 as well as systolic heart failure, 147 both conditions known to be associated with Cheyne-Stokes respiration.…”

Section: Central Sleep Apneamentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

144

125

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors-some of them unique to COPD-can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPDan association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifi cally in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Keywords: COPD, insomnia, obstructive sleep apnea, restless legs syndrome, hypoventilation Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259-270.pii: jc-00080-14 http://dx.doi.org/10.5664/jcsm.4540 T hat sleep is adversely affected in chronic obstructive pulmonary disease (COPD) has been long recognized. 1 COPD affects 5% to 10% of the adult population in the United States and is a major contributor to global disease burden. 2 The prevalence of insomnia symptoms, insomnia disorder, restless leg syndrome, and hypoxemia is increased in COPD. [3][4][5] Furthermore, polysomnographic (PSG) evaluation generally reveals decreased sleep effi ciency and lower mean overnight oxygen saturation in COPD patients compared to controls. 6 In COPD, the pathogenesis of sleep disorders appears to be a complex and multifactorial process, likely consequent to one or more of the following: physiological changes associated with sleep, hypoxemia, hypercapnia, infl ammation, COPD medications, and/or nicotine use. Comorbid disorders as well as primary sleep disturbances may also contribute to disrupted sleep in COPD patients. For example, nocturnal gastroesophageal refl ux (GERD) is associated with both symptoms of sleep apnea and COPD, and may contribute to the pathogenesis, and concomitant occurrence of both disorders.7 GERD may also infl uence sleep quality which could potentially contribute to some of the sleep complaints reported by persons with COPD. 8 The following sections describe the diverse sleep disorders and sleep-related abnormalities encountered in patients with COPD. Sleep Disorders in Chronic Obstructiv...

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“…Furthermore, many of the advanced lung diseases treated with lung transplant are associated with a high prevalence of diastolic dysfunction, ranging from 20% to 70% (13)(14)(15)(16)(17)(18)(19). Multiple mechanisms may mediate the development of abnormal diastolic function in chronic lung diseases (16,(19)(20)(21)(22)(23)(24)(25)(26)(27). Chronically increased right ventricular (RV) afterload, RV dysfunction, and lung hyperinflation decrease LV preload, which can lead to LV atrophy and abnormal myocyte relaxation (16,19,(21)(22)(23)(24)(25)(26)(27).…”

mentioning

confidence: 99%

Diastolic Dysfunction Increases the Risk of Primary Graft Dysfunction after Lung Transplant

Porteous

Kirkpatrick

et al. 2016

Am J Respir Crit Care Med

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Rationale: Primary graft dysfunction (PGD) is a significant cause of early morbidity and mortality after lung transplant and is characterized by severe hypoxemia and infiltrates in the allograft. The pathogenesis of PGD involves ischemia-reperfusion injury. However, subclinical increases in pulmonary venous pressure due to left ventricular diastolic dysfunction may contribute by exacerbating capillary leak.Objectives: To determine whether a higher ratio of early mitral inflow velocity (E) to early diastolic mitral annular velocity (é), indicative of worse left ventricular diastolic function, is associated with a higher risk of PGD.Methods: We performed a retrospective cohort study of patients in the Lung Transplant Outcomes Group who underwent bilateral lung transplant at our institution between 2004 and 2014 for interstitial lung disease, chronic obstructive pulmonary disease, or pulmonary arterial hypertension. Transthoracic echocardiograms obtained during evaluation for transplant listing were analyzed for E/é and other measures of diastolic function. PGD was defined as Pa O 2 /FI O 2 less than or equal to 200 with allograft infiltrates at 48 or 72 hours after reperfusion. The association between E/é and PGD was assessed with multivariable logistic regression.Measurements and Main Results: After adjustment for recipient age, body mass index, mean pulmonary arterial pressure, and pretransplant diagnosis, higher E/é and E/é greater than 8 were associated with an increased risk of PGD (E/é odds ratio, 1.93; 95% confidence interval, 1.02-3.64; P = 0.04; E/é .8 odds ratio, 5.29; 95% confidence interval, 1.40-20.01; P = 0.01).Conclusions: Differences in left ventricular diastolic function may contribute to the development of PGD. Future trials are needed to determine whether optimization of left ventricular diastolic function reduces the risk of PGD.

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High Prevalence of Left Ventricle Diastolic Dysfunction in Severe COPD Associated with A Low Exercise Capacity: A Cross-Sectional Study

Cited by 56 publications

References 38 publications

Right ventricular diastolic function and exercise capacity in COPD

Right ventricular diastolic function and exercise capacity in COPD

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Diastolic Dysfunction Increases the Risk of Primary Graft Dysfunction after Lung Transplant

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