Diastolic function abnormalities in ICU patients with chronic obstructive pulmonary disease

Introduction

It has been shown from several studies that patients with right ventricle pressure overload often have left ventricular (LV) diastolic dysfunction. Our aim was to evaluate LV function in ICU patients with chronic obstructive pulmonary disease (COPD).

Methods

We studied 35 patients (20 males, 15 females), mean age 65 ± 8.4 years, with COPD and without comorbidities (hypertension, diabetes, coronary heart disease or heart failure). Twenty-five healthy subjects matched for age and sex were used for control. Using conventional echocardiography, the LV end diastolic diameter (LVD), LV ejection fraction (EF%), right ventricle diastolic diameter (RVD), right ventricle systolic pressure (RVSP), the maximal velocity of E wave, maximal velocity of A wave, and E/A ratio were assessed. Using tissue Doppler echocardiography, Em, Am and Em/Am were calculated.

Results

The differences between groups are presented in Figure 1. The parameters of the diastolic LV function, E/A and Em/Am were significantly lower in COPD patients in comparison with healthy subjects. There was also a significant negative correlation between RVSP and Em/Am (r = -0.74, P < 0.01) and E/A (r = 0.5; P < 0.005).

Figure 1

Conclusion

Systolic LV function is well preserved in COPD patients but we found a severe LV diastolic impairment that might be due to alterations of the chamber stiffness from the hypertrophic right ventricle.