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Original Research: COPD |

Left Ventricular Hypertrophy in COPD Without HypoxemiaLeft Ventricular Hypertrophy in COPD: The Elephant in the Room?

William J. Anderson, MBChB; Brian J. Lipworth, MD; Sushma Rekhraj, MBChB; Allan D. Struthers, MD; Jacob George, MD
Author and Funding Information

From the Centre for Cardiovascular and Lung Biology, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland.

Correspondence to: Jacob George, MD, Centre for Cardiovascular and Lung Biology, Level 7, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland; e-mail: j.george@dundee.ac.uk


Funding/Support: This study was funded by a grant from the University of Dundee Anonymous Trust.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):91-97. doi:10.1378/chest.12-0775
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Background:  COPD is associated with significant cardiovascular mortality. Left ventricular hypertrophy (LVH) is a pivotal cardiovascular risk factor. The prevalence of LVH in COPD is currently unknown.

Methods:  We performed a pilot study of 93 normoxemic patients with COPD and 34 control subjects. Patients underwent echocardiography to measure left ventricular (LV) dimensions, ECG, measurement of serum B-type natriuretic peptide (BNP) levels, and 24-h BP recording. Spirometry and oxygen saturations were also recorded.

Results:  The oxygen saturations of patients with COPD were normal, at 96.5% (95% CI, 96.1%-97.0%), with a mean FEV1 of 70.0% predicted (95% CI, 65.2%-74.8%). A total of 30.1% of patients with COPD met the echocardiographic criteria for LVH based on LV mass index, with more LVH in female patients than in male patients (43.2% vs 21.4%, P = .02). The LV mass index in patients with COPD was 96.2 g/m2 (95% CI, 90.1-102.7 g/m2) vs 82.9 g/m2 (95% CI, 75.8-90.6 g/m2) in control subjects (P = .017). The LV mass index remained high in patients with COPD in the absence of a hypertension history (94.5 g/m2 vs 79.9 g/m2, P = .015) and with 24-h systolic BP < 135 mm Hg (96.7 g/m2 vs 82.5 g/m2, P = .024). The LV ejection fraction (mean = 63.4%) and BNP (mean = 28.7 pg/mL) were normal in patients with COPD. The mean 24-h BP was normal in patients with COPD, at 125/72 mm Hg. ECG was less sensitive for detecting LVH than was echocardiography.

Conclusion:  LVH with normal LV ejection fraction and BNP levels was present in a significant proportion of normotensive, normoxemic patients with COPD, especially female patients. Clinical trials are, therefore, indicated to evaluate treatments to regress LVH in patients with COPD.

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