Left ventricular diastolic dysfunction, though known in COPD patients, is quite frequent in advanced COPD sufferers to our experience. We studied the presence of diastolic dysfunction in 43 (GOLD stage IIb and III) patients and its association with several clinical variables that appeared important from our experience in an OPD based study.
This was a cross sectional survey of patients in a tartiary clinic using the following variables: easy fatiguability, disproportionate tachycardia, poor clinical response to treatment, poor exercise tolerence, FEV1, cardiothoracic ratio, and cardiomegaly. The known predisposing factors for diastolic dysfunction as ischemic heart disease and hypertension were recorded. Thereafter, the patients underwent 2D doppler echocardiography to detect the presence of diastolic dysfunction. Finally, the association of diastolic dysfunction was evaluated with the variables of interest.
Cardiothoracic ratio greater than 0.4, cardiomegaly and subjective easy fatiguability were found to be significantly associated with diastolic dysfunction. Low FEV1 (less than 35% predicted) and disproportionate tachycardia were the other two risk factors though they could not achieve statistical significance in explaining diastolic dysfunction.
Diastolic dysfunction appear in about 70 % of advanced COPD patients independent of the presence of ischemia or hypertension. Cardiothoracic ratio greater than 0.4 and easy faiguability are the two independent predictors of diastolic dysfunction in advanced COPD sufferers. However, further evaluation is necessary to unveil the COPD-diastolic dysfunction association.
Intervention of diastolic dysfunction in advanced COPD patients may help in ameliorating symptoms as dyspnoea or easy fatiguability with improvement in the functional ability.
Parthasarathi Bhattacharyya, None.