title: Left ventricular structure and remodeling in patients with COPD.
abstract: BACKGROUND
  Data on cardiac alterations such as left ventricular (LV) hypertrophy, diastolic dysfunction, and lower stroke volume in patients with COPD are discordant. In this study, we investigated whether early structural and functional cardiac changes occur in patients with COPD devoid of manifest cardiovascular disease, and we assessed their associations with clinical and functional features.
  
  
  METHODS
  Forty-nine patients with COPD belonging to all Global Initiative for Chronic Obstructive Lung Disease (GOLD) classes were enrolled and compared with 36 controls. All subjects underwent clinical history assessment, lung function testing, blood pressure measurement, electrocardiography, and conventional and Doppler tissue echocardiography. Patients were also subjected to computed tomography to quantify emphysema score.
  
  
  RESULTS
  Patients with COPD had lower LV cavity associated with a marked increase in relative wall thickness (RWT), suggesting concentric remodeling without significant changes in LV mass. RWT was significantly associated with ratio of the forced expiratory volume in 1 second to the forced vital capacity and emphysema score and was the only cardiac parameter that - after multivariate analysis - significantly correlated with COPD conditions in all individuals. Receiver operating characteristic curve analysis showed that RWT (with a cutoff point of 0.42) predicted the severity of COPD with 83% specificity and 56% sensitivity (area under the curve =0.69, 95% confidence interval =0.59-0.81). Patients with COPD showed right ventricular to be functional but no structural changes.
  
  
  CONCLUSIONS
  Patients with COPD without evident cardiovascular disease exhibit significant changes in LV geometry, resulting in concentric remodeling. In all individuals, RWT was significantly and independently related to COPD. However, its prognostic role should be determined in future studies.
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital Parma, Parma, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Pelà
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital Parma, Parma, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Li Calzi
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital Parma, Parma, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Pinelli
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital Parma, Parma, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Andreoli
authors.affiliation: Department of Surgery, University Medical School, University Hospital Parma, Parma, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Sverzellati
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital Parma, Parma, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Bertorelli
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital Parma, Parma, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Goldoni
authors.affiliation: Department of Clinical and Experimental Medicine, University Hospital Parma, Parma, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Chetta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: COPD; Doppler tissue echocardiography; emphysema score; left ventricular function; left ventricular remodeling; right ventricular function