Abstract 3626: Tissue Doppler Imaging is Useful to Detect Subclinical Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease Without Pulmonary Hypertension
Introduction: Right and/or left ventricular heart failure are not uncommon in patients with chronic obstructive pulmonary disease (COPD). However, it is unknown if subclinical cardiac dysfunction exists before the occurrence of pulmonary hypertension.
Hypothesis: Tissue Doppler imaging (TDI) helps to identify the early impairment of ventricular function in COPD.
Methods: 67 stable COPD patients (no acute exacerbation in the past 3 months) without pulmonary hypertension [pulmonary artery systolic pressure (PASP) <35mmHg by Doppler echocardiography] and history of clinical heart failure were compared with 50 normal controls. Using color tissue Doppler imaging (TDI), tricuspid annular motion displacement, peak systolic (Sm) and peak early diastolic (Em) velocity in basal right ventricular (RV) segment as well as the mean values of 6 basal left ventricular (LV) segments were measured.
Results: There was no difference in PASP (19.7±9.7 vs. 18.0±9.5mmHg) and RV ejection fraction (59.1±8.0 vs. 59.6±8.1%) between controls and COPD patients. LV ejection fraction was slightly lower in COPD (68.2±4.5 vs. 63.2±7.3%, p<0.001), which was <50% in only 1 patient. In contrast, TDI showed significant reduction in tricuspid annular motion displacement, Sm and Em velocities in LV and RV basal segments (Table⇓). The extent of decline in Sm (11 to 13%) was smaller than that of Em (34 to 42%). Furthermore, the prevalence of systolic and diastolic dysfunction in COPD patients was 24%, 38% for LV, and 14%, 22% for RV, respectively, when the cutoff values derived from the controls (-2SD from mean) were used.
Conclusions: Early asymptomatic impairment of LV and/or RV function was evident in stable patients with COPD before development of pulmonary hypertension, by the use of TDI.