Decreasing Cardiac Chamber Sizes and Associated Heart Dysfunction in COPD

Watz, Henrik; Waschki, Benjamin; Meyer, Tanja; Kretschmar, Gunther; Kirsten, Anne; Claussen, Martin; Magnussen, H

doi:10.1378/chest.09-2810

Cited by 258 publications

(238 citation statements)

References 41 publications

Supporting

Mentioning

195

Contrasting

Unclassified

Order By: Relevance

“…WATZ et al [25] extended these findings by demonstrating that hyperinflation correlated with decreased LV end-diastolic diameter across all Global Initiative for Chronic Obstructive Lung Disease stages. Importantly, impaired LV diastolic filling was independently associated with reduced 6-min walk distance [25]. Thus, reducing hyperinflation and improving stroke volume, as shown in our study, may lead to improved functional status.…”

Section: Discussionmentioning

confidence: 86%

“…While most studies showing similar findings have been conducted in severe COPD, recent studies have shown that impaired left ventricle (LV) filling is related to per cent emphysema on computed tomography scan even in cases of mild airflow obstruction [24]. WATZ et al [25] extended these findings by demonstrating that hyperinflation correlated with decreased LV end-diastolic diameter across all Global Initiative for Chronic Obstructive Lung Disease stages. Importantly, impaired LV diastolic filling was independently associated with reduced 6-min walk distance [25].…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Increased oxygen pulse after lung volume reduction surgery is associated with reduced dynamic hyperinflation

et al. 2012

View full text Add to dashboard Cite

Stroke volume augmentation during exercise is limited in chronic obstructive pulmonary disease patients because of decreased preload from dynamic hyperinflation (DH). We hypothesised that oxygen pulse and pulse pressure (PP) improve following lung volume reduction surgery (LVRS), and the magnitude of improvement correlates with reduction in DH.We compared 16 emphysema patients undergoing LVRS with six emphysema patients not undergoing LVRS. Oxygen pulse and PP were calculated from maximal cardiopulmonary exercise tests at baseline and 6 months. End-expiratory lung volume (EELV)/total lung capacity (TLC) represented DH. Comparisons were made between baseline and 6 months at metabolic isotimes (per cent maximal carbon dioxide production (V9CO 2 ,max)).At baseline, the LVRS group was older with higher forced expiratory volume in 1 s, but had similar hyperinflation to the non-LVRS group. At 6 months, oxygen pulse (50%, 75%, and 100% V9CO 2 ,max) and PP (50% and 75% V9CO 2 ,max) increased in the LVRS, but not in the non-LVRS group. Baseline functional residual capacity/TLC inversely correlated with resting oxygen pulse (r5 -0.449, p50.04). Decreased EELV/TLC correlated with increased oxygen pulse at 75% (r5 -0.487, p50.02) and 100% V9CO 2 ,max (r5 -0.548, p50.008).LVRS led to increased oxygen pulse and PP during exercise at metabolic isotimes 6 months following surgery. Reductions in DH correlated with increases in oxygen pulse during exercise. Reducing lung volume may improve stroke volume response to exercise by decreasing DH.KEYWORDS: Cardiopulmonary interactions, chronic obstructive pulmonary disease, exercise, physiology C hronic obstructive pulmonary disease (COPD) patients have impaired exercise tolerance, which limits their quality of life. While ventilatory limitations, including dynamic hyperinflation (DH), are the main cause of exercise intolerance in this population [1], causes for this impairment are probably multifactorial [2]. Impairment in cardiac mechanics in COPD may be one of the most important contributing factors. Stroke volume is reduced in COPD, especially during exercise [3]. Decreased stroke volume is due to increased intrathoracic pressures and decreased cardiac right-sided filling [4][5][6].Along with its beneficial effects on mortality [7] and pulmonary function [8], lung volume reduction surgery (LVRS) improves exercise capacity by altering lung mechanics [7,9,10]. LVRS also favourably affects stroke volume, both at rest [8] and during exercise [11]. Increased right ventricular stroke volume post-LVRS has been reported to correlate with decreased resting hyperinflation [11]. The effect of DH on cardiac function during exercise in COPD, however, is unknown.To investigate the effect of DH and LVRS on cardiac performance during exercise, we retrospectively analysed data from emphysema patients who had cardiopulmonary exercise tests (CPETs) before and after LVRS, and compared their changes with those who did not undergo LVRS. We hypothesised that LVRS would lead to an increase in no...

show abstract

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 92%

Increased oxygen pulse after lung volume reduction surgery is associated with reduced dynamic hyperinflation

et al. 2012

View full text Add to dashboard Cite

show abstract

“…It is potentially clinically relevant for two reasons. First, among patients with COPD, LV diastolic dysfunction based on E/A ratio is common [14][15][16]26,35 ; however, these mitral infl ow abnormalities can refl ect increased stiffness of the LV or states of low LV fi lling pressure. [17][18][19] Our fi ndings suggest low LV distending pressure resulting from upstream pulmonary causes rather than intrinsic cardiac dysfunction may contribute signifi cantly to impaired LV fi lling in COPD.…”

Section: Discussionmentioning

confidence: 99%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

View full text Add to dashboard Cite

1143C hronic lower respiratory disease is the third-leading cause of death in the United States. 1 The most morbid components of chronic lower respiratory dis ease are COPD, defi ned by spirometry as airfl ow obstruction that is not fully reversible, and pulmonary emphysema, defi ned by morphology as permanent enlargement of airspaces accompanied by destruction of their walls. 2,3 Emphysema on CT imaging is present in approximately one-half of patients with COPD, 4-7 and an estimated 2% of the general population aged . 50 years has emphysema without spirometry-defi ned COPD. 8 The number of Americans with a diagnosis of heart failure was 5.7 million in 2008, and approximately one-half of prevalent heart failure cases are characterized by preserved ejection fraction. 9,10 By comparison, 12 million Americans have a diagnosis of COPD and an additional 12 million may have undiagnosed COPD and emphysema. 11Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) fi lling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defi ned by spirometry. Percent emphysema was defi ned as regions , 2 910 Hounsfi eld units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean ( Ϯ SD) total pulmonary vein area was 558 Ϯ 159 mm 2 in patients with COPD and 623 Ϯ 145 mm 2 in control subjects. Total pulmonary vein area was smaller in patients with COPD ( 2 57 mm 2 ; 95% CI, 2 106 to 2 7 mm 2 ; P 5 .03) and inversely associated with percent emphysema ( P , .001) in fully adjusted models. Signifi cant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defi ned COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These fi ndings support a mechanism of upstream pulmonary causes of underfi lling of the LV in COPD and in patients with emphysema on CT scan. CHEST 2013; 144(4):1143-1151Abbreviations: E/A ratio 5 ratio of peak fi lling rates during early phase diastole and atrial contraction; E/A ratioMR 5 ratio of peak fi lling rates during early phase diastole and atrial contraction estimated by magnetic resonance; EDV 5 end-diastolic volume; LV 5 left ventricle; MESA 5 Multi-Ethnic Study of Atherosclero...

show abstract

“…Hyperinflated lungs in COPD can often be seen to push the diaphragm caudally on a chest radiograph; such increased intrathoracic pressure can often impair low pressure ventricular filling [46]. This may become much more clinically apparent on exercise and lead to reduced physical activity.…”

Section: Heart Failure Secondary To Impaired Fillingmentioning

confidence: 99%

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

Patel

Hurst

2011

Expert Review of Respiratory Medicine

137

108

View full text Add to dashboard Cite

Decreasing Cardiac Chamber Sizes and Associated Heart Dysfunction in COPD

Cited by 258 publications

References 41 publications

Increased oxygen pulse after lung volume reduction surgery is associated with reduced dynamic hyperinflation

Increased oxygen pulse after lung volume reduction surgery is associated with reduced dynamic hyperinflation

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

Contact Info

Product

Resources

About