The right way to the left chamber in non-severe COPD: Echocardiographic predictors for stress-induced left ventricular diastolic dysfunction [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2020; 48(4): 380-391 | DOI: 10.5543/tkda.2020.89238

The right way to the left chamber in non-severe COPD: Echocardiographic predictors for stress-induced left ventricular diastolic dysfunction

Radostina Cherneva1, Stefan Denchev2, Zheyna Cherneva2
1Department of Pulmonology, University Hospital for Respiratory Diseases St. Sophia, Sofia
2Department of Cardiology, Medical Institute of the Ministry of Internal Affairs, Sofia


OBJECTIVE
Dyspnea is a major complaint of both chronic obstructive pulmonary disease (COPD) and heart failure with preserved ejection fraction (HFpEF). It often remains underdiagnosed in COPD patients when only echocardiography at rest is performed. The aim of this study was to evaluate the predictive value of cardiopulmonary and echocardiographic parameters at rest for the diagnosis of HFpEF in non-severe COPD patients who complain of exertional dyspnea and have no overt cardiovascular disease.

METHODS
A total of 104 COPD patients underwent echocardiography before cardiopulmonary exercise testing (CPET) and 12 minutes after peak exercise. The patients were divided into 2 groups based on peak E/e measurements: patients with masked HFpEF-stress and left ventricular diastolic dysfunction (LVDD; E/e>15), and patients without masked HFpEF (without stress LVDD). CPET and echocardiographic parameters at rest were measured and the predictive value for stress E/e was analyzed.

RESULTS
Stress LVDD occurred in 67 of 104 patients (64%). These patients achieved a lower work load, lower VO2 consumption, lower minute ventilation, and higher VE/VCO2 slope in comparison with patients without stress LVDD. None of the CPET values correlated with stress E/e. The best independent predictors for stress LVDD were right atrium volume index (RAVI), right ventricle (RV) parasternal diameter, and RV E/A >0.75. The combination of these echocardiographic parameters predicted HFpEF with an accuracy of 91.2%.

CONCLUSION
There is a high prevalence of stress LVDD in non-severe COPD patients with exertional dyspnea who remain free of overt cardiovascular disease. RAVI, RV parasternal diameter, and RV E/A >0.75 were the only independent predictors of stress LVDD.

Keywords: Cardiopulmonary exercise testing, chronic obstructive pulmonary disease; heart failure with preserved ejection fraction; stress echocardiography.

How to cite this article
Radostina Cherneva, Stefan Denchev, Zheyna Cherneva. The right way to the left chamber in non-severe COPD: Echocardiographic predictors for stress-induced left ventricular diastolic dysfunction. Turk Kardiyol Dern Ars. 2020; 48(4): 380-391

Corresponding Author: Zheyna Cherneva, Bulgaria
Copyright 2020 Archives of the Turkish Society of Cardiology
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