title: Assessment of right ventricular geometry and mechanics in chronic obstructive pulmonary disease patients living at high altitude.
abstract: Degree of increase in pulmonary artery pressure (PAP) and adaptive responses in right ventricular morphology and mechanics play an important role in the prognosis of chronic obstructive pulmonary disease (COPD) patients. Three dimensional echocardiography and deformation imaging are recent advancements in echocardiography that allow more through assessment of right ventricle. We aimed to investigate right ventricular geometry and mechanics in a stable COPD population living at moderately high altitude. A total of 26 stable COPD patients with variable disease severity were included to this study. Pulmonary function tests, six minutes walking test (6MWT) and two- and three-dimensional echocardiography were performed for evaluation and data collection. Both systolic (43.06 ± 11.79 mmHg) and mean (33.38 ± 9.75 mmHg) PAPs were significantly higher in COPD patients compared to controls (p < 0.05, p < 0.001; respectively). Right ventricular volumes were similar between groups, although right ventricular free wall thickness was significantly increased in COPD group. The number of subjects with a sub-normal (<40 %) right ventricular ejection fraction was significantly higher in COPD group (45.8 vs. 17.4 %, p < 0.05), and the mean right ventricular strain was significantly lower (-21.05 ± 3.80 vs. -24.14 ± 5.37; p < 0.05). Only mean PAP and body surface area were found as independent predictors for 6MWT distance. Increased PAP and reduced right ventricular contractility were found in COPD patients living at moderately high altitude, although right ventricular volumes were normal. Similar findings can be expected in other COPD patients with high PAP, since these findings probably represents the effect of increased PAP on right ventricular mechanics.
authors.affiliation: Department of Cardiology, School of Medicine, Kafkas University, Kars, Turkey.
authors.forename: Tolga Sinan
authors.initials: TS
authors.lastname: Güvenç
authors.forename: Seref
authors.initials: S
authors.lastname: Kul
authors.forename: Coşkun
authors.initials: C
authors.lastname: Doğan
authors.forename: Binnaz Zeynep
authors.initials: BZ
authors.lastname: Yıldırım
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Karabağ
authors.forename: Rengin
authors.initials: R
authors.lastname: Cetin
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Kaya
authors.forename: Pelin
authors.initials: P
authors.lastname: Karadağ
authors.forename: Aleks
authors.initials: A
authors.lastname: Değirmencioğlu
authors.forename: Bahattin
authors.initials: B
authors.lastname: Balcı
mesh_terms: D000368:Aged; D000531:Altitude; D062186:Arterial Pressure; D001830:Body Surface Area; D016022:Case-Control Studies; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D019560:Echocardiography, Three-Dimensional; D005080:Exercise Test; D005260:Female; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D013147:Spirometry; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right