PURPOSE: To evaluate the parameters of right ventricular (RV) size, systolic and diastolic function and quality of life (QOL) in patients with right heart failure (RHF).
METHODS: 45 patients (males, mean age 57±8 years, range 43-75) with very severe COPD, complicated by pulmonary hypertension (PAH) and RHF were studied. All patients underwent clinical, laboratory examination, spirometry and echocardiography. Mean FEV1 was 30±8% predicted (range 17-48%). RV wall thickness and RV end-diastolic size were evaluated with 2D-echocardiography. The RV systolic function was measured by pulsed wave Doppler tissue imaging (DTI). The RV diastolic function was measured by pulsed Doppler and DTI. The tricuspid inflow profile (E, A, E/A, DT) and hepatic vein flow velocity (S, D, A) were measured by pulsed Doppler. Peak velocities of the tricuspid annular motion (Sa, Ea, Aa, Ea/Aa) were measured using DTI. QOL was assessed with Minnesota Living with Heart Failure questionnaire (MLHFQ).
RESULTS: RV remodeling was detected in 100% of patients (mean RV wall thickness 7.0±1.0 mm; mean RV end-diastolic size 42.0±4.0 mm). All the above patients had RV diastolic dysfunction. Impaired relaxation pattern of tricuspid inflow was detected in 71.1% (32 patients), pseudonormal pattern - in 17.8% (8 patients), restrictive pattern - in 11.1% (5 patients). 13.3% (6 patients) had RV systolic dysfunction (Sa<11.5 cm/s). Mean QOL score was 56.3±10.8 (range 37-71). There were significant correlations between QOL score and tricuspid annular motion (Ea/Aa (r=-0.56; p=0.01), RV wall thickness (r=0.65; p=0.001) and RV end-diastolic diameter (r=0.68; p=0.001).
CONCLUSIONS: Our study confirmed that patients with COPD complicated by PAH and RHF have decreasing QOL. QOL score correlated with RV remodeling and dysfunction markers.
CLINICAL IMPLICATIONS: Physicians should take into consideration decreasing QOL in COPD patients complicated by PAH and RHF to improve management and rehabilitation programs.
DISCLOSURE: The following authors have nothing to disclose: Vasily Pyankov, Yulia Chuyasova
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