PURPOSE: To discriminate causal origin of asymmetric septal hypertrophy(ASH),in chronic obstructive pulmonary disease(COPD).
METHODS: Fourty two dyspnea patients (Pts),32 males and 10 females,mean age 68 years,with COPD underwent: 1. Lung function tests and arterial blood gasses 2.Echocardiography 3.Evaluation of Biomarkers,including serum Homocysteine (Hcy), NT-ProBNP, Troponin (Tr- I), Erythropoeitin(EPO), cytokine IL-1a, Metallo- proteinase-2(MMP-2),and Metalloproteinase-9(MMP-9).
RESULTS: The results showed:1)Respiratory indices of severe obstruction and mild restriction or conjestion,moderate hypoxemia,alveolar-arterial oxygen difference [P(A-a)O2]=46mmHg and DLCO=67% 2) Echocardiographic ejection fraction(EF)=60%(<45% in 9,5% pts),left atrial dimention(LAD)=4,3cm,right ventricular systolic pressure(RVSP)=46mm Hg,asymmetric septal hypertrophy(ASH)=1,5(31%),diastolic dysfunction in 45% pts 3)Abnormal serum values of NT-ProBNP=3378pg/ml,Hcy=18μmol/L,Tr I=0,5ng/ml,EPO=25m/U/ml,IL- 1a=15pg/ml,MMP-2=248pg/ml,MMP-9=891pg/ml 4)Primary significant correlations of a)ASH to NT-ProBNP,Hcy,EPO,IL-1a b)NT-ProBNP to EF and Hcy c)Hcy to Tr-I d) EPO to LAD e) MMP-2 to MMP-9.
CONCLUSIONS: COPD “induced” ASH 1) did not seem correlated at all to any respiratory function indices 2)Unlike, ASH significant correlations to Hcy,IL-1a,and NT-ProBNP,similarly relating to EF and IL-1a may express inflammatory,ischemic ventricular dysfunction 3)Hcy significant correlations to Tr-I and ASH to EPO ,relating with LAD,may be leading to ischemic damage quided ,latent cardiovascular remodeling,also being promoted by MMP-2 and MMP-9.
CLINICAL IMPLICATIONS: Further studies are needed,establishing ASH causal diagnostic criteria in pts with chronic obstructive pulmonary disease.
DISCLOSURE: The following authors have nothing to disclose: Ioannis Angomachalelis, George Kyriazis, Demosthenes Bouros, Nestor Angomachalelis
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