Turk Kardiyol Dern Ars. Ahead of Print: TKDA-89238 | 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
, Stefan Denchev2
, Zheyna Cherneva21
1University Hospital For Respiratory Diseases st. Sophia, Sofia2
2University Hospital 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 when only echocardiography at rest is applied. The aim of the study was to evaluate the predictive value of cardio-pulmonary and echocardiographic parameters at rest for the diagnosis of HFpEF in non-severe COPD patients, who complain of exertional dyspnea and are free of overt cardiovascular diseases.
METHODS 104 COPD patients underwent echocardiography before cardio-pulmonary exercise testing (CPET) and 1-2 minutes after peak exercise. Patients were divided into two groups based on peak E/e: patients with masked HFpEF - stress 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 their predictive value for stress E/e was analysed.
RESULTS Stress LVDD occurred in 67/104 patients (64%). These patients achieved lower work load, lower VO2 consumption, lower minute ventilation and higher VE/VCO2 slope in comparison to patients without stress LVDD. None of the CPET correlated to stress E/e. The best independent predictors for stress LVDD were right atrium volume index (RAVI), right ventricular (RV) parasternal diameter and RV E/A >0.75. The combination of these echocardiographic parameters predicted HFpEF with the accuracy of 91.2%.
CONCLUSION There is a high prevalence of stress LVDD in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular diseases. RAVI, RV parasternal diameter and RV E/A >0.75 were the only independent predictors of stress LVDD.
cardio-pulmonary exercise testing, stress echocardiography, heart failure with preserved ejection fraction, chronic obstructive pulmonary disease
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Corresponding Author: Zheyna Cherneva, Bulgaria