Right ventricular diastolic function and exercise capacity in COPD

Abstract

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.

Echocardiographic Assessment of the Right Heart in Adults: A Practical Guideline from the British Society of Echocardiography

“…Figure 2 summarises key indices in the echocardiographic assessment of RV diastolic function. Fenster et al (13) Chronic obstructive pulmonary disease TV E/A ratio, RV E′, post-bronchodilator FEV1/FVC, and use of oxygen during 6-minute walk test were independent predictors of exercise capacity. Pagourelias et al (14) Hypertrophic cardiomyopathy RV E/E′ >6.9 was an independent predictor of heart failure mortality and total cardiovascular mortality.…”

Right Ventricular Damage Under Diastolic Dysfunction of Different Severity in Patients With Ischemic Heart Disease

“…Также у больных ХОБЛ более высокие значения отношения E / A на трикуспидальном клапане были ассоциированы с повышением дистанции 6-мин ходьбы (p=0,001). В то же время другие показатели диастолической функции ПЖ (e', DT и E / e') не коррелировали с толерантностью к физической нагрузке при данном тесте [3]. Неодинаковая диагностическая ценность показателей диастолической функции ПЖ отмечена и в настоящем исследовании, причем наиболее информативным оказался показатель, характеризующий распространения потока раннего диастолического наполнения ПЖ.…”

“…Тем не менее в последнее время исследователи все больше внимания стали уделять патологии правых отделов сердца [2]. Негативное влияние на клиническое состояние их дисфункции показано при хронических заболеваниях легких [3], легочной гипертензии [4], врожденных пороках сердца [2]. Однако и в других случаях (при АГ, ИБС, ХСН) патология правых отделов сердца встречается часто [5][6][7] и ее изучение оказалось полезным как для оценки клинического состояния, так и прогноза.…”

Ehokardiografija u ranoj detekciji poremećaja funkcije desne komore pri promjeni volumena krvi kod bolesnika na hemodijalizi

“…Dijastolna disfunkcija desne komore ima klinički značaj jer može biti korisna kao rani i lako mjerljiv marker njene supkliničke disfunkcije [26,27]. Mnoge studije su pokazale da je dijastolna disfunkcija desne komore obično već prisutna i prije nego sistolna disfunkcija postane očigledna, odnosno i prije dilatacije ili hipertrofije desne komore.…”