Archives of the Turkish Society of Cardiology
The “right way” to the left chamber in non-severe COPD - echocardiographic predictors for stress induced left ventricular diastolic dysfunction [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. Ahead of Print: TKDA-89238 | DOI: 10.5543/tkda.2020.89238

The “right way” to the left chamber in non-severe COPD - echocardiographic predictors for stress induced left ventricular diastolic dysfunction

Radostina Cherneva1, Stefan Denchev2, Zheyna Cherneva2
11University Hospital For Respiratory Diseases “st. Sophia’’, Sofia
22University Hospital Of The Ministry Of Internal Affairs, Sofia


OBJECTIVE
Dyspnea is a major complaint of both chronic obstructive pulmonary disease (COPD) and heart failure with preserved ejection fraction (HFpEF). It often remains underdiagnosed in COPD when only echocardiography at rest is applied. The aim of the study was to evaluate the predictive value of cardio-pulmonary and echocardiographic parameters at rest for the diagnosis of HFpEF in non-severe COPD patients, who complain of exertional dyspnea and are free of overt cardiovascular diseases.

METHODS
104 COPD patients underwent echocardiography before cardio-pulmonary exercise testing (CPET) and 1-2 minutes after peak exercise. Patients were divided into two groups based on peak E/e’: patients with masked HFpEF - stress left ventricular diastolic dysfunction (LVDD; E/e’ > 15) and patients without masked HFpEF (without stress-LVDD). CPET and echocardiographic parameters at rest were measured and their predictive value for stress E/e’ was analysed.

RESULTS
Stress LVDD occurred in 67/104 patients (64%). These patients achieved lower work load, lower ’VO2 consumption, lower minute ventilation and higher ’VE/’VCO2 slope in comparison to patients without stress LVDD. None of the CPET correlated to stress E/e’. The best independent predictors for stress LVDD were right atrium volume index (RAVI), right ventricular (RV) parasternal diameter and RV E/A >0.75. The combination of these echocardiographic parameters predicted HFpEF with the accuracy of 91.2%.

CONCLUSION
There is a high prevalence of stress LVDD in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular diseases. RAVI, RV parasternal diameter and RV E/A >0.75 were the only independent predictors of stress LVDD.

Keywords: cardio-pulmonary exercise testing, stress echocardiography, heart failure with preserved ejection fraction, chronic obstructive pulmonary disease

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Corresponding Author: Zheyna Cherneva, Bulgaria
© Copyright 2020 Archives of the Turkish Society of Cardiology
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