Up-to-date right ventricular diastolic function in Chronic Obstructive Pulmonary Disease (COPD) patients (pts)has not been thoroughly investigated. Thus, there is always a great dilemma to be recognised, whether right ventricular diastolic dysfunction (RVVD)and/or failure, related to COPD pathophysiology, is, indeed, a fact, fiction or a dilemma for new therapeutic interventions.
Fourty three consecutive pts with COPD and 14 age and heart rate-matched controls underwent M-Mode and Acoustic Quantification (AQ) echocardiographic evaluation of right ventricular systolic (RVS) and diastolic function, Doppler transtricuspid flow estimation and lung function tests (spirometry and blood gases analysis), as well as radionuclide ventriculography with Technetium-99m-pyrophosphate (Multigated Acquisition, MUGA).Pts were classified in three groups:Group A (mean FEV1>70% predicted), Group B (50%<FEV1<69%), Group C (FEV1<50%), according to the ERS Consensus Statement.
It was resulted that right ventricular systolic dysfucntion (RVSD)in COPD pts was found in 16/43 pts(37.2%) by AQ (FAC<39%)and in 13/43 pts (30.23%) by MUGA(RVEF<45%).Transtricuspid diastolic flow evaluation by Dopper showed diastolic abnormalities of relaxation type in 23 pts (53.4%), whereas AQ diastolic indices indicated the same pattern of RVDD in 20 pts (43.5%).Correlations of diastolic AQ and Doppler indices with lung function tests and blood gases abnormalities as well as with M-Mode indices of cor pulmonale were statistically significant.
We conclude, that, altough RVS function remains normal in the first two stages of COPD, RVDD becomes evident earlier in the progress of the second and mainly the third stage of the disease in conjunction with the development of respiratory impairment and chronic cor pulmonale, followed very frequently by clinical symptoms and signs of right ventricular failure. Furthermore, RVDD is statistically proven to play an important role in the pathophysiology of right ventricular failure.
Is it consequently the time for establishing new therapeutic interventions targeting the early asymptomatic and symptomatic stages of the disease, including the RVDD itself?.
Nestor Angomachalelis, None.