ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN STABLE COPD PATIENTS

1. ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN STABLE COPD PATIENTS ArnabMaji, Jayanta Kr Mallick, KaushikSaha, SupriyaSarakar Dept. of Pulmonary Medicine, N.R.S. Medical College, Kolkata, India

2. INTRODUCTION It is now increasingly acknowledged that COPD patients have increased incidence of left ventricular dysfunction even in absence of ischemic heart disease, rheumatic heart disease, hypertensive heart disease, congenital and valvular heart disease.

3. BACKGROUND • Previous studies suggested LV diastolic dysfunction was seen in COPD patients with normal pulmonary arterial pressure and it increased with right ventricular afterload 1. • Few studies have found no left ventricular dysfunction in COPD patients 2. • A recent study from Rajasthan, India done over 40 patients of COPD has shown 7.50% patients had left ventricle (LV) systolic dysfunction and 47.5% patients had evidence of LV diastolic dysfunction 3.

4. AIMS AND OBJECTIVES • To find out LV dysfunction in COPD patients. • To find out any correlation between LV dysfunction in echocardiography with severity and duration of COPD, ECG and chest x-ray findings.

5. Inclusion criteria All confirmed, stable, and uncomplicated COPD cases (diagnosed on the basis of GOLD 2007) attending our department during the stipulated one year study period were included in the study.

6. Exclusion criteria • Patients with acute exacerbation of COPD. • Patients with apparent cardiac disease. • Patients with ECG findings suggestive of left heart disease or arrhythmia. • Patients with CXR suggestive of left ventricular hypertrophy. • Patient with poor echo-window (severe hyper inflated lungs). • Patients refused to give informed written consent.

7. Materials

8. Methods Detailed history, clinical examination and chest x-ray Diagnosis confirmed by spirometry and staged as per GOLD criteria Patients with underlying LV disease diagnosed on the basis of history, clinical findings, electrocardiography and echocardiography were excluded All cases were subjected to 2D echocardiography for LV systolic (LVEF) and diastolic function ( early rapid filling phase /late rapid filling phase ,deceleration time ,volumetric relaxation time.) Statistical analysis done by chi-square test and r value with the help of Microsoft excel and epi–info (3.5.1) software

9. RESULTS

10. Age distribution of study population

11. Staging of the study population according to GOLD criteria

12. Echocardiographic assessment of left ventricular function

13. Correlation between Patients’ Age and LV dysfunction

14. Correlation between duration of symptoms and LV diastolic dysfunction

15. Correlation between ECG findings and LV diastolic dysfunction

16. Correlation between chest x-ray findings and LV dysfunction

17. Correlation between GOLD staging with LV diastolic dysfunction

18. Conclusion • There was a definite association between LV diastolic dysfunction and COPD even in absence of known LV disease. • There is definite statistical correlation between LV dysfunction with severity and duration of COPD, age of the patient, ECG and chest x-ray findings.

19. Limitation of the study • Small sample size • No control was taken

20. References • Funk GC, Lang I, Schenk P,Valipour A, Hartl S, Burghuber OC. Left Ventricular Diastolic Dysfunction in patients With COPD in the Presence and Absence of Elevated Pulmonary Arterial Pressure:Chest 2003;133:1354-9. • Murphy ML, Adamson J, Hutcheson F. Left ventricular hypertrophy in patients with chronic bronchitis and emphysema. Ann Intern Med 1974;81:307-313. • Gupta NK, Agrawal RK, Srivastav AB, Ved ML. Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease. Lung India 2011;28:105-108.

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