PURPOSE: Cor pulmonale is the pulmonary arterial hypertension (PHT) caused by diseases affecting the structure and/or the function of the lungs leading to right ventricular hypertrophy (RVH), dilatation or both. The main objective of this research is to identify the relationship between COPD and cor pulmonale through an empirical study.
METHODS: Pulmonary function test (PFT) records of a patient group of year 2005 were reviewed and 203 patients with FEV1/FVC% less than 70% were identified. The following data were obtained from the PFT records: patient demographics, exposure to tobacco-smoke measured in pack-years, FEV1%, and FEV1/FVC%. According to their Medical records; 61/203pts have been undergone transthoracic echocardiography evaluation during year 2004-2005. The pulmonary arterial systolic pressure (PASP), presence or absence of RVH and/or dilatation, left ventricular ejection fraction, left atrial and ventricular morphology data were abstracted from echocardiography results. PASP greater than 30mmHg defined as PHT. Records were further searched to exclude comorbid conditions known to cause PHT including sleep apnea, restrictive pulmonary disease, pulmonary embolism, portal hypertension, collagen vascular disease, and systemic hypertension. According to the severity of COPD described in GOLD classification, patients were classified into four-groups: 1) FEV1%≥80, 2) 50≤FEV1%<80, 3) 30≤FEV1%<50, and 4) FEV1%<30.
RESULTS: Out of 203 patients (mean age 64), 54% were male and most were heavy smokers (mean 31.88pack-years). The 61 patients who had echocardiography reports showed mean FEV1% of 58.18. Out of 61 patients 40 had findings suggestive of underlying heart pathology with mean age of 68. 21/61 had COPD without co-morbid cardiac conditions, among them only 3 (mean FEV1% 71.66) had PHT (mean 33mmHg) without any additional cause of pulmonary pressure elevation. Total of 14/61 had PHT. 11/14(78.57%) had a heart pathology. 8/11(72.73%) had PASP > 40mmHg.
CONCLUSION: Cor pulmonale is uncommon even among patients with advanced COPD.
CLINICAL IMPLICATIONS: When PHT is diagnosed in patients with COPD another etiology should be investigated. Left ventricular hypertrophy and diastolic dysfunction may be the major underlying etiology in an aging population.
DISCLOSURE: Inoka Devapriya, None.