title: Airflow limitation in COPD is associated with increased left ventricular wall stress in coincident heart failure.
abstract: BACKGROUND
  COPD and heart failure occur with a considerable coincidence. Beside well-known mechanisms of increased right heart load in COPD, dedicated changes of the left ventricle (LV) are ill-defined and the question remains, whether specific interactions exist beyond common shared risk factors.
  
  
  METHODS
  LV wall stress was calculated based on cardiac magnetic resonance imaging in 28 patients with COPD (GOLD I to III) and coexistent heart failure (LVEF 42 ± 19%) due to non-ischaemic and ischaemic cardiomyopathy.
  
  
  RESULTS
  LV enddiastolic (p = 0.048) and endsystolic wall stress (p = 0.034) increased from GOLD stage I to III. Reduced FEV1 was correlated with increased enddiastolic (p = 0.0210) and endsystolic LV volume (p = 0.0413) and with increased enddiastolic (p = 0.0161) and endsystolic LV wall stress (p = 0.0315), respectively. Increased wall stress was associated with a decreased FEV1/FVC ratio.
  
  
  CONCLUSIONS
  The severity of airflow limitation in COPD was correlated with increased LV wall stress. It is suggested that respiration in pulmonary obstruction is associated with an increased negative intrathoracic pressure when compared with normal lung function, which is transmitted to the heart and increases the transmural pressure gradient and thereby distending forces on the heart. Increased ventricular wall stress is known to be associated with a broad variety of unfavourable consequences, which should be taken into account to contribute to a worse prognosis in COPD.
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Germany. Electronic address: alter@uni-marburg.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Alter
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: van de Sand
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nell
authors.affiliation: Department of Radiology, University of Marburg, Germany.
authors.forename: Jens H
authors.initials: JH
authors.lastname: Figiel
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Greulich
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Germany.
authors.forename: Claus F
authors.initials: CF
authors.lastname: Vogelmeier
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Germany. Electronic address: koczulla@med.uni-marburg.de.
authors.forename: Andreas R
authors.initials: AR
authors.lastname: Koczulla
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D013147:Spirometry / Q000379:methods; D013314:Stress, Mechanical; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology; D014797:Vital Capacity / Q000502:physiology
keywords: Airflow limitation; COPD; Cardiac magnetic resonance; Heart failure; Non-ischaemic cardiomyopathy; Obstruction; Respiration; Ventricular wall stress