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Abstract: Background: Chronic
obstructive pulmonary disease (COPD) is a systemic inflammatory disease, with
irreversible airflow obstruction, disease with high morbidity and early
mortality rate. COPD is not just a disorder limited to the lungs. As the
disease progresses, extra pulmonary co morbidities occur, where cardiovascular
diseases are the most common. They mostly affect the right side of the heart,
but sometimes changes also occur on the left side of the heart, as a result of
long-term strain from the right ventricle (RV) and pulmonary hypertension which
follows COPD. Material and methods: The design of our study was
prospective-clinical cross-sectional study with 2 years follow up. In the study
were included 94 patients with previously confirmed chronic obstructive
pulmonary disease with spirometry and classified by Tiffeneau index in four
gold classes. We have analyzed the values of some echocardiographic parameters
that were selected as indicators of left heart function, and also we have
analyzed them in relation to the progression of COPD from milder to more severe
Golden classes, such as: left ventricular diastolic dimension (LvdD - mm), left
ventricular ejection fraction (EF %), myocardial performance index (MPI) of the
left ventricle, global longitudinal strain (Gl strain - %) of LV, diastolic
function (E/e'). Echo analysis was done by Vivid 7 echo machine with a special
feature to left heart chamber characteristics and function. Results: All
echocardiographic parameters analyzed in our study, underline their
significance in disease progression in patients with COPD and increasing Gold
classes. A varies of statistical methods and parameters were used to evaluate:
left ventricular diastolic dimension(mm), Ejection fraction of left ventricle
(%), MPI of the left ventricle obtain by Tissue Doppler, GL strain of left
ventricle (%) and E/e' in correlation of disease progression and GOLD class.
Echo-parameters MPI of the left ventricle and Global longitudinal strain LV
(%), progressively grow with the rise of the gold class (form I to IV). On the
contrary the values of the parameters LvdD and EF% gradually decrease with the
progression of the disease and gold class. Echocardiographic parameter GL
strain LV % has the highest value and statistically by decreasing the values of
this parameter the risk of disease progression from gold stage I/II to Gold
stage III/IV is 1.570 times higher, with high statistical
significance(p<0,01). The calculated value of the parameter EF% is lower
than 0,75, which indicates that the model of prediction is not the best one but
it's acceptable. Conclusion: COPD is a progressive disease that affects the dimensions of the right and left heart chambers, as well as the function of both chambers and the development of pulmonary hypertension. Monitoring echocardiographic parameters intended for assessment cardiac dimension and function can help tо predict disease progression for timely inclusion of specific therapeutic strategies. We suggest screening of all COPD patients for cardiac assessment using echocardiography as a non-invasive and repeatable method for their follow-up. |
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