title: Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity.
  
  
  METHODS
  The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography.
  
  
  RESULTS
  Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (p<0.05) and blockage of the anterosuperior division of the left bundle branch were higher in patients with greater obstruction. In an echocardiographic analysis, mild/moderate chronic obstructive pulmonary disease patients showed more abnormalities in segmental contractility (p<0.05), whereas severe/very severe chronic obstructive pulmonary disease patients showed a higher prevalence of right ventricular overload (p<0.05), increased right cardiac chamber (p<0.05) and higher values of E-wave deceleration time (p<0.05). Age, sex, systemic arterial hypertension, C-reactive protein and disease were included as independent variables in a multiple linear regression; only disease severity was predictive of the E-wave deceleration time [r²=0.26, p=0.01].
  
  
  CONCLUSIONS
  Chronic obstructive pulmonary disease patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. Because of this association, it is important to exclude decompensated heart failure during chronic obstructive pulmonary disease exacerbation.
authors.affiliation: Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Disciplina de Pneumologia, Botucatu/SP, Brazil. laucaram@hotmail.com
authors.forename: Laura Miranda de Oliveira
authors.initials: LM
authors.lastname: Caram
authors.forename: Renata
authors.initials: R
authors.lastname: Ferrari
authors.forename: Cristiane Roberta
authors.initials: CR
authors.lastname: Naves
authors.forename: Suzana Erico
authors.initials: SE
authors.lastname: Tanni
authors.forename: Liana Sousa
authors.initials: LS
authors.lastname: Coelho
authors.forename: Silméia Garcia
authors.initials: SG
authors.lastname: Zanati
authors.forename: Marcos Ferreira
authors.initials: MF
authors.lastname: Minicucci
authors.forename: Irma
authors.initials: I
authors.lastname: Godoy
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D003971:Diastole; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D012016:Reference Values; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology
chemical_list: D002097:C-Reactive Protein