Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Abstract

It was hypothesised that, apart from right ventricular (RV) dysfunction, patients with idiopathic pulmonary fibrosis (IPF) also exhibit left ventricular (LV) impairment, which may affect disease progression and prognosis. The aim of the present study was to evaluate LV performance in a cohort of IPF patients using conventional and tissue Doppler echocardiography.IPF patients exhibiting mild-to-moderate pulmonary arterial hypertension (mean age 65¡9 yrs; n522) and healthy individuals (mean age 61¡6 yrs; n522) were studied. Conventional and tissue Doppler echocardiography were used for the evaluation of RV and LV systolic and diastolic function.In addition to the expected impairment in RV function, all patients showed a characteristic reversal of LV diastolic filling to late diastole compared with controls (early diastolic peak filling velocity (E)/late diastolic peak filling velocity 0.7¡0.2 versus 1.5¡0.1, respectively). Patients with IPF also exhibited lower peak myocardial velocities in early diastole (Em; 5.7¡1.1 versus 10.3¡1.6 cm?s -1 , respectively), higher in late diastole (Am; 8.9¡1.3 versus 5.5¡0.8 cm?s -1 , respectively), lower Em/Am ratio (0.6¡0.1 versus 1.9¡0.5, respectively) and higher E/Em ratio (10.8¡3 versus 6¡0.6, respectively), all indicative of LV diastolic dysfunction. Moreover, LV propagation velocity was significantly lower in IPF patients (46¡13 versus 83¡21 cm?s -1 , respectively).Physicians should be aware that patients with idiopathic pulmonary fibrosis exhibit early impairment of left ventricular diastolic function.

Left ventricular dysfunction in patients with interstitial lung diseases

“…The presented spirometric and blood gas parameters were lower in our patient group in comparison to those presented by PAPADOPOULOS et al [1] (forced vital capacity (FVC): 37¡15 versus 61¡15 % predicted; arterial oxygen tension: 47¡8 versus 62¡6 mmHg (6.2¡1.0 versus 8.3¡0.8 kPa)). Also, the achieved distance in a 6-min walking test (6MWT) was shorter (255¡180 versus 450¡147 m).…”

“…Most studies have demonstrated that the underfilled left ventricle found in RV pressure overload conditions, such as idiopathic pulmonary fibrosis (IPF), has relatively preserved systolic function [1,2]. GOTO et al [3] showed that increasing RV pressure by pulmonary artery constriction caused regional changes in systolic shortening in the anterior, posterior, and lateral walls of the left ventricle and the septum.…”

“…PAPADOPOULOS et al [1] stated that the systolic function of the LV is preserved in patients with IPF. In our group, the systolic parameter of LV (estimated ejection fraction (EF)) was also satisfying (average EF 55.3¡4.7%).…”

“…The paper by PAPADOPOULOS et al [1] describes the failure of systolic left ventricular (LV) function in patients with idiopathic lung fibrosis (IPF).…”

“…The control group consisted of 22 patients with ILD that had been evaluated for lung transplantation, but did not meet all ATS/ERS criteria for intervention. Similarly to PAPADOPOULOS et al [1], we excluded patients with coexistent heart-circulation diseases or other diseases which might affect the LV function. The echocardiogram included two-dimensional examination with colour-doppler and pulsative parameters according to the recommendation of the American Echocardiography Society [4].…”