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Early Right Ventricular Dysfunction in Smokers With COPD and Reduced Diffusion Capacity for Carbon Monoxide (Dlco) FREE TO VIEW

Alessia Verduri, MD; Chiara Leuzzi, MD; Andrea Barbieri, MD; Pietro Roversi, MD; Letizia Reggianini, MD; Fabrizio Luppi, MD; Enrico Clini, MD; Leonardo M. Fabbri, MD; Maria G. Modena, MD; Bianca Beghé, MD
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Respiratory Department, University of Modena and Reggi, Italy

Chest. 2010;138(4_MeetingAbstracts):866A. doi:10.1378/chest.10626
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PURPOSE: Cigarette smoking, major risk factor for COPD, causes lung and systemic inflammation that could contribute to development of chronic diseases other than COPD. The most common chronic conditions associated with COPD include cardiovascular (CV) disease. The aim of the study was to investigate the presence of right ventricular (RV) and left ventricular (LV) dysfunction in patients with COPD, clinically free of CV disease.

METHODS: A cohort of selected outpatients with confirmed diagnosis of COPD (according to GOLD guidelines), aged >50 yrs, with >10 pack/years, was evaluated. In each subject body mass index (BMI), Charlson Comorbidity Index and MMRC dyspnea scale were recorded and echocardiography was performed. LV systolic dysfunction was defined as a LV ejection fraction <40%. LV diastolic dysfunction was classified in 4 stages according to recently published recommendation. RV systolic function was evaluated with Tricuspid annulus peak systolic velocity by Doppler Tissue Imaging and Tricuspid Annular Plane Systolic Excursion (TAPSE). RV diastolic dysfunction was classified in 4 stages based on tricuspid velocity and right atrial volume. The maximum peak tricuspid regurgitation velocity plus mean right atrial pressure estimated from the respiratory changes in inferior vena cava diameter was used to determine the Doppler-derived pulmonary artery systolic pressure (PASP).

RESULTS: We analyzed 45 COPD pts (33 M), mean age 68 yrs (range 50-87), BMI mean±SD 27.5±4, mean pack/years 48. The severity of COPD was GOLD stage I in 7 pts, GOLD II in 25, GOLD III in 13. Age-adjusted mean Charlson Index was 4 (range 2-7) and mean MMRC scale 1.5 (range 0-4). Among all the echocardiographic parameters indicative of LV and RV function, we found a significant correlation between TAPSE and DLCO (Spearman’ s r=0.35, p<0.05) associated with a trend between PASP and DLCO (Spearman’ s r=-0.17), not statistically significant.

CONCLUSION: COPD patients with reduced DLCO may have sub-clinical RV systolic dysfunction and increased PASP.

CLINICAL IMPLICATIONS: These changes suggest the early occurrence of cardiac dysfunction in this subgroup of COPD patients. Funded by Progetto Regionale RFPS, AIFA, Fondazione Chiesi.

DISCLOSURE: Alessia Verduri, No Financial Disclosure Information; No Product/Research Disclosure Information

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