Left ventricular dysfunction in deteriorating patients with chronic obstructive pulmonary disease.
OBJECTIVE
To evaluate the effectiveness of simple clinical variables and radionuclide ventriculogram in separating those patients with isolated chronic obstructive pulmonary disease (COPD) from those with COPD and coexisting left ventricular dysfunction (LVD).


METHODS
Retrospective record review of 77 patients with increasing dyspnea, defined as recent deterioration in exercise tolerance, new use of corticosteroids, or recent hospital admission for COPD; referred to the outpatient Pulmonary Rehabilitation Program at the Cincinnati Veterans Affairs Medical Center from July 1987 to October 1992.


METHODS
Outpatient medical clinic.


METHODS
Veterans who were referred to the Pulmonary Rehabilitation Program.


METHODS
History and physical findings, pulmonary function tests, arterial blood gases, distance achieved in a 12-min walk, dyspnea score, electrocardiogram, chest radiograph, and radionuclide multigated ventriculography.


RESULTS
Twenty-five of 77 patients evaluated in the Pulmonary Rehabilitation Program for increasing dyspnea were functionally more limited (12-min walk 10.4 vs 13.9 laps; MRC score 2.68 vs 2.06; p < 0.05) and had left ventricular dysfunction (LVD) (left ventricular ejection fraction < 40%) associated with wall motion abnormalities on radionuclide ventriculogram. Careful standard clinical evaluation did not separate those patients with COPD from those with both COPD and LVD.


CONCLUSIONS
LVD was found in 32% of patients with COPD presenting with symptomatic deterioration. Since the therapeutic approach to these two disorders differs, the identification of patients with LVD is important. Prospective studies are needed to identify the most cost-effective approach to this problem of coexisting disease and to evaluate the benefit from therapy.
Render
M L
ML
Medical Service, Veterans Affairs Medical Center, University of Cincinnati.
Weinstein
A S
AS
Blaustein
A S
AS
D000368:Aged; D004562:Electrocardiography; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications* / Q000175:diagnosis; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis