title: High Prevalence of Left Ventricle Diastolic Dysfunction in Severe COPD Associated with A Low Exercise Capacity: A Cross-Sectional Study.
abstract: A subclinical left ventricle diastolic dysfunction (LVDD) has been described in patients with chronic obstructive pulmonary disease (COPD).
  
  
  
  To evaluate the prevalence of LVDD in stable severe COPD patients, to analyze its relationship with exercise capacity and to look for its possible causes (lung hyperinflation, ventricular interdependence or inflammatory mechanisms).
  
  
  
  We evaluated 106 consecutive outpatients with severe COPD (FEV1 between 30-50%). Thirty-three (31%) were excluded because of previous heart disease. A pulmonary function test, a 6-minute walking test (6MWT), a Doppler echocardiography test, including diastolic dysfunction parameters, and an analysis of arterial blood gases, NT-proBNP and serum inflammatory markers (CRP, leucocytes), were performed in all patients.
  
  
  
  The prevalence of LVDD in severe stable COPD patients was 90% (80% type I, n=57, and 10% type II, n=7). A significant association between a lower E/A ratio (higher LVDD type I) and a lower exercise tolerance (6-minute walked distance (6MWD)) was found (r=0.29, p<0.05). The fully adjusted multivariable linear regression model demonstrated that a lower E/A ratio, a DLCO in the quartile 4(th) and a higher tobacco consumption were associated with a lower 6MWD (76, 57 and 0.7 metres, respectively, p<0.05). A significant correlation between E/A ratio and PaO2 was observed (r=0.26, p<0.05), but not with static lung hyperinflation, inflammation or right ventricle overload parameters.
  
  
  
  In stable severe COPD patients, the prevalence of LVDD is high and this condition might contribute in their lower exercise tolerance. Hypoxemia could have a concomitant role in their pathogenesis.
authors.affiliation: Department of Pulmonary Medicine, Hospital Universitari de Bellvitge, 2. Pneumology Research Group, Institut d´Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: López-Sánchez
authors.forename: Mariana
authors.initials: M
authors.lastname: Muñoz-Esquerre
authors.forename: Daniel
authors.initials: D
authors.lastname: Huertas
authors.forename: José
authors.initials: J
authors.lastname: Gonzalez-Costello
authors.forename: Jesús
authors.initials: J
authors.lastname: Ribas
authors.forename: Federico
authors.initials: F
authors.lastname: Manresa
authors.forename: Jordi
authors.initials: J
authors.lastname: Dorca
authors.forename: Salud
authors.initials: S
authors.lastname: Santos
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*
chemical_list: D015415:Biomarkers