Left ventricular failure secondary to chronic pulmonary disease

Rao, B S Shankaranarayana; Cohn, Keith; Eldridge, Frederíc L.; Hancock, E. William

doi:10.1016/0002-9343(68)90041-7

Cited by 130 publications

(36 citation statements)

References 43 publications

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“…An alternative explanation for the apparent interdependence of the right and left ventricles, as suggested in this study, is the observation reported over 50 yrs ago that the left ventricular free wall thickness in emphysematous patients with no left-sided cardiac disease was abnormally increased [37]. Others have demonstrated anatomical as well as functional evidence indicating that LVD is not uncommon in patients with chronic right ventricular pressure overload [38,39]. This, however remains controversial [40].…”

Section: Discussionsupporting

confidence: 48%

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

J¹,

Lao²,

Karetzky³

1996

Eur Respir J

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The incidence and pathogenesis of right ventricular dysfunction in obstructive sleep apnoea (OSA) remains controversial. Using nuclear ventriculography, the prevalence of right ventricular dysfunction (RVD) was therefore determined in obese patients with OSA, as well as their clinical characteristics, arterial blood gas values, spirometry and sleep parameters. The reversibility of RVD was evaluated after long-term use of nasal continuous positive airway pressure (nCPAP).We studied 112 obese patients with OSA by nuclear ventriculography, 35 with RVD (Group 1), 77 without RVD (Group 2), and 14 patients without OSA as controls (Group 3). Repeat nuclear ventriculography was performed in seven patients who used nCPAP nightly for 6-24 months.The mean right ventricular ejection fractions (RVEF) were 31%, 47% and 44% in Groups 1, 2 and 3, respectively. Group 1 also had a lower left ventricular ejection fraction (LVEF) of 55 vs 63% in Group 2. The OSA groups did not differ in mean spirometric or arterial blood gas values. Group 1 had a lower mean nocturnal arterial oxygen saturation (Sa,O 2 ) of 82 vs 87% in Group 2, and a longer apnoea duration of 22.3 vs 19.2 s. All but two patients in Group 1 had either awake alveolar hypoventilation or an apnoea + hypopnoea index >40 disordered breathing events·h -1 . Repeat nuclear ventriculography after nCPAP revealed an increase in RVEF from 30 to 39%.In conclusion, right ventricular dysfunction is common in obstructive sleep apnoea, but it is reversible with nasal continuous positive airway pressure treatment and appears to be related to nocturnal oxygen desaturation. Eur Respir J., 1996, 9, 945- [8]. In patients with OSA, left ventricular failure has been demonstrated to exist in the absence of ischaemic or valvular heart disease, and to be reversible with the long-term use of nasal continuous positive airway pressure [9][10][11][12]. Pulmonary hypertension and cor pulmonale have similarly been reported to be associated with OSA [13][14][15][16], but have been attributed to coexisting chronic obstructive pulmonary disease (COPD) [14,15].In a study of 50 patients with OSA, a 12% incidence of right ventricular failure (RVF) was found on the basis of clinical examination and radiological or electrocardiographic criteria [16]. The authors suggested that a "sustained hypoxaemia and/or hypercapnia over a 24 h period" was a necessary prerequisite for the development of RVF in patients with OSA [16]. Another study of 114 OSA patients reported similar relationships between pulmonary hypertension and obstructive lung disease, but 35% of the patients with pulmonary hypertension were not found to have lower airways obstruction [17].To further define and characterize obese patients with OSA who are at increased risk of right (RVD) and left ventricular dysfunction (LVD), we prospectively investigated the sleep parameters, pulmonary function, arterial blood gas values and radionuclide ejection fractions in 126 patients. The effect of long-term treatment utilizing nCPAP on right and ...

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Section: Discussionsupporting

confidence: 48%

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

J¹,

Lao²,

Karetzky³

1996

Eur Respir J

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“…The pulmonary arterial wedge pressure in exercise was found elevated in a significant number of patients [7,9,13,14,[17][18][19][20]22], particularly in those with marked pulmonary arterial hypertension and RHF. The pos sible complex mechanisms of increased Ppaw.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Function and Pulmonary Hemodynamics During Exercise in Patients with Chronic Obstructive Bronchopulnonary Disease

Ježek

Schrijen

Sadoul³

1973

Cardiology

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Central hemodynamics were examined in 50 patients with chronic obstructive bronchopulmonary disease at rest and during mild steady-state supine exercise. The cardiac output rose proportionally to increased oxygen uptake in most cases; there was no difference between the patients with and without chronic right heart failure (RHF). The mean pulmonary arterial pressure in exercise increased disproportionally to cardiac output in about half of the compensated patients and in all cases with RHF. The pulmonary vascular resistance did not change significantly. The right ventricular end-diastolic pressure (RVEDP) at rest was significantly higher in the patients with RHF than in the other but the individual variations were large. Thus, the resting RVEDP cannot be considered as a reliable sign of RV functional abnormality in individual cases. Better agreement with clinical classification of the patients was obtained when considering the exercise values of RVEDP and particularly the relation of RVEDP to stroke volume during exercise.

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“…[14][15][16][17][18][19] Postmortem reports have revealed the presence of left ventricular hypertrophy in a significant percentage of patients with COPD. [14][15][20][21][22] The measurement of LV function was difficult and complicated until the advent of non-invasive techniques.…”

Section: Discussionmentioning

confidence: 99%

Clinical and phonocardiographic evaluation of left ventricular function in patients with chronic obstructive pulmonary disease

Vasista¹,

Bhattad²

2017

Int J Res Med Sci

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Background: Chronic obstructive pulmonary disease (COPD) is a term to describe a group of diseases (chronic bronchitis and emphysema). The status of left ventricular (LV) function in patients with COPD has been a controversial subject. Given the ambiguity in correlation of LV dysfunction and COPD, this study was planned to assess the relationship between LV function and COPD.Methods: This was an observational study done in 40 adult patients with acute exacerbation of COPD. The enrolled patients were divided into 2 major groups. Group A - predominant emphysema and Group B - predominant bronchitis. Phonocardiogram (PCG), carotid pulse tracing and ECG were done to measure LV ejection time (LVET) and pre-ejection period (PEP).Results: FEV1 impairment was greater (severe to very severe grade) in the majority (77%) of patients of group B, whereas the majority (77.2%) of group A patients had lesser degree of FEV1 impairment (mild to moderate). PEPI were observed to be prolonged and LVETI were observed to be shortened. PEP/LVET ratio was observed to be prolonged in 77.5% of patients in stable condition. PEP/LVET ratio was abnormally prolonged (>0.42) to a greater extent in patients of group B than in patients of group A.Conclusions: LV dysfunction is commonly encountered in patients with COPD and was observed to be exaggerated during an acute exacerbation. It was maximum in patients with chronic bronchitis with cor pulmonale with CCF and lesser in patients with chronic bronchitis without cor pulmonale or CCF and least in patients with emphysema.

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Left ventricular failure secondary to chronic pulmonary disease

Cited by 130 publications

References 43 publications

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

Right ventricular dysfunction in obstructive sleep apnoea: reversal with nasal continuous positive airway pressure

Right Ventricular Function and Pulmonary Hemodynamics During Exercise in Patients with Chronic Obstructive Bronchopulnonary Disease

Clinical and phonocardiographic evaluation of left ventricular function in patients with chronic obstructive pulmonary disease

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