Left ventricular diastolic dysfunction is common in patients with chronic obstructive pulmonary disease and is associated with worse prognosis
█ Original article
Hajdu Máté1, Krämer Konrád1, Vértes Vivien1, Nógrádi Ágnes1, Varga Noémi2, Illés Miklós Balázs3, Sárosi Veronika4, Faludi Réka1
¹Pécsi Tudományegyetem, Klinikai Központ, Szívgyógyászati Klinika, Pécs
²Medicover Klinika, Pécs
3Landeskrankenhaus – Universitätsklinikum Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Pulmonologie, Graz, Ausztria
4Pécsi Tudományegyetem, Klinikai Központ, I.sz. Belgyógyászati Klinika, Pulmonológia Tanszék, Pécs
Background: Chronic obstructive pulmonary disease (COPD) and heart failure seem to coexist more frequently than expected based on their prevalence. Thus we aimed to estimate the prevalence and to investigate the prognostic value of the diastolic dysfunction in COPD patients.
Patients and methods: 66 patients (60.5±8.9 years) were enrolled into our retrospective study. They underwent echocardiography between December 2013 and May 2014. Left ventricular ejection fraction and left atrial volume were measured by 2D Simpson’s method. In addition to the spectral Doppler parameters of the transmitral flow (E, A), myocardial systolic (S), and early- (e’) and late- (a’) diastolic velocities were measured on the mitral annulus by tissue Doppler technique. E/A and E/e’ ratios were calculated. Survival of patients was assessed after 4.5 years. Since the exact cause of death was often unknown, all-cause mortality was chosen as outcome.
Results: Impaired relaxation pattern was found in 29 (43.9%) patients. Doppler data suggested elevated filling pressure in 18 (27.3%) patients, including 17 (25.8%) and 1 (1.5%) cases with pseudonormal and restrictive mitral inflow pattern, respectively. During the follow-up period of 4.5±0.6 years, 5 (7.6%) patients died. By multivariate Cox regression analysis, E/e’ ratio was the only independent predictor of mortality (HR (95% CI)=1.372 (1.104–1.706); p=0.004). Using ROC analysis, E/e’ ratio ≥9.7 was the strongest predictor of the mortality (sensitivity=80%, specificity=77%, AUC=0.727).
Conclusion: Left ventricular diastolic dysfunction is common in COPD, especially the impaired relaxation pattern. Among the investigated parameters, E/e’ ratio was proved to be the only independent predictor of all-cause mortality.