title: Right ventricular systolic dysfunction is related to exercise intolerance in patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To evaluate the impact of right ventricular dysfunction on exercise tolerance and potential changes resulting from exercise training in patients with chronic obstructive pulmonary disease (COPD) undergoing pulmonary rehabilitation.
  
  
  METHODS
  Subjects were 44 patients with a history of symptomatic (Global Initiative for Chronic Obstructive Lung Disease classes 2-4) COPD attending a 4-week aerobic exercise training program. Right ventricle dysfunction was evaluated by echocardiography at admission using tricuspid annular plane systolic excursion (TAPSE). Exercise tolerance was evaluated at admission and discharge using the 6-minute walk test (6MWT). Change in distance walked (Δ6MWT) was defined as the difference between 6MWT distance at discharge minus distance at admission. Patients were divided into 2 groups according to the presence of right ventricle dysfunction (TAPSE ≤16 mm).
  
  
  RESULTS
  Median age and left ventricular ejection fraction was 70.2 ± 5.2 years and 54.4 ± 9.1%, respectively. Of the 44 patients, 14 (31.8%) had TAPSE ≤16 mm. Baseline 6MWT distance was less in the group with TAPSE ≤16 mm compared with TAPSE >16 mm (110.2 ± 34 vs 185.7 ± 41, respectively; P = .02). After the training program, 6MWT distance increased in both groups, but there was less increase in the group with TAPSE ≤16 mm compared with TAPSE >16 mm (+24.3% vs +32.8%, respectively; P < .001). Tricuspid annular plane systolic excursion was significantly correlated to distance walked at the baseline 6MWT (r = 0.44; P = .002) and to Δ6MWT (r = .36; P = .006).
  
  
  CONCLUSIONS
  Tricuspid annular plane systolic excursion ≤16 mm was an indicator of decreased 6MWT distance at baseline and 6MWT distance change in COPD patients undergoing pulmonary rehabilitation. This relationship seems to be independent of pulmonary function.
authors.affiliation: Department of Medical Sciences, Cardiovascular Research Unit, San Raffaele IRCCS, Rome, Italy (Dr Caminiti); Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome, Italy (Dr Cardaci, Dr Conti, Dr Battaglia, Mr D'Antoni, and Dr Volterrani); and Dipartimento di Medicina Fisica e Riabilitazione, Università Tor Vergata, Rome, Italy (Mr Murugesan).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caminiti
authors.forename: Vittorio
authors.initials: V
authors.lastname: Cardaci
authors.forename: Vittoria
authors.initials: V
authors.lastname: Conti
authors.forename: Valentino
authors.initials: V
authors.lastname: DʼAntoni
authors.forename: Jeganath
authors.initials: J
authors.lastname: Murugesan
authors.forename: Daniela
authors.initials: D
authors.lastname: Battaglia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Volterrani
mesh_terms: D000368:Aged; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000534:rehabilitation; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging*