Impact of chronic obstructive pulmonary disease with pulmonary hypertension on both left ventricular systolic and diastolic performance.
BACKGROUND
The effects of chronic obstructive pulmonary disease (COPD) on right ventricular (RV) systolic and diastolic functions and left ventricular (LV) diastolic function have been shown. Whereas LV myocardial performance index (LVMPI), which incorporates ejection and isovolumic relaxation and contraction times and is an index of global ventricular function, has not yet been evaluated in COPD.


METHODS
Our study population consisted of 24 age-matched control subjects (group 1), 24 patients with COPD without pulmonary hypertension (group 2), and 20 patients with COPD with pulmonary hypertension (group 3). Pulmonary function tests, analyses of arterial blood gases, and transthoracic echocardiographic examination were performed. RV myocardial performance index (RVMPI) and LVMPI were obtained by pulsed wave Doppler tissue.


RESULTS
RVMPI was higher in both group 2 (0.61 +/- 0.15) and group 3 (0.94 +/- 0.27) than group 1 (0.41 +/- 0.08) (P = .038 and P< .001, respectively), and was higher for group 3 than in group 2 (P = .018). LVMPI was higher for group 3 (0.77 +/- 0.25) than in both group 1 (0.49 +/- 0.08) and group 2 (0.59 +/- 0.10) (P = .001 and P = .037, respectively). However, difference between groups 1 and 2 was not significant (P > .05). For patients with COPD, LVMPI was positively correlated with age, heart rate, pulmonary arterial systolic pressure, RVMPI, and partial pressure of carbon dioxide, and negatively correlated with tricuspid annular plane systolic excursion, forced expiratory volume in 1 second, and partial pressure of oxygen. In multiple linear regression analysis (R2 = 0.676), LVMPI was independently associated with forced expiratory volume in 1 second (Beta = 0.549, P = .017), pulmonary arterial systolic pressure (Beta = 0.488, P = .014), and RVMPI (Beta = 0.278, P = .042).


CONCLUSIONS
Both LV systolic and diastolic functions are impaired in COPD, especially in patients with pulmonary hypertension. This impairment is independently associated with pulmonary arterial systolic pressure, RVMPI, and forced expiratory volume in 1 second.
Yilmaz
Remzi
R
Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey. drremziyilmaz@yahoo.com
Gencer
Mehmet
M
Ceylan
Erkan
E
Demirbag
Recep
R
D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D003971:Diastole; D005260:Female; D006339:Heart Rate; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right