Echocardiographic Detection of Occult Cor Pulmonale During Exercise in Patients with Chronic Obstructive Pulmonary Disease

Abstract

We tested the ability of cycle ergometer exercise echocardiography to detect cases of occult cor pulmonale among 25 patients with chronic obstructive pulmonary disease (COPD). The M-mode echocardiographic ventricular septal motion, left ventricular shape determined by short-axis two-dimensional (2-D) echocardiography, and right and left ventricular pressure curves were recorded at rest and during exercise and were compared between patients. The ventricular septal motion was normal at rest in all of the patients. In nine patients (dip group), there was marked downward ventricular septal motion in early diastole during exercise, indicating distortion of the left ventricular shape. There were no distinct changes in the remaining 16 patients (non-dip group). At rest, the cardiac index was significantly lower, and right ventricular systolic and mean pulmonary artery pressures were significantly higher in the dip group than in the non-dip group. However, no significant difference was noted in the right ventricular end-diastolic pressure between the two groups at rest. The right ventricular systolic and end-diastolic pressures were greater during exercise in the dip group than in the non-dip group. In all of the patients in the dip group, the right ventricular pressure exceeded the left ventricular pressure only in early diastole, coinciding with the early diastolic dip of the ventricular septum, during exercise. In conclusion, occult cor pulmonale can be diagnosed accurately by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during exercise in patients with COPD.

Effects of right ventricular dysfunction on exercise capacity and quality of life and associations with serum NT-proBNP levels in COPD: an observational study

“…We also demonstrated the correlations between SF-36 domains with pulmonary function test results and positive correlations between SF-36 domains with PVO 2 and AT values consistent with the literature (19, 37, 38). However we did not find relationship between PH and quality of life.…”

“…Kruger et al (34) have also found negative correlation between serum BNP level with PVO 2 and AT values in 70 patients with congestive heart failure. Eroğlu et al (35) evaluated the relationship between BNP levels and CPET parameters in patients with dyspnea and isolated left ventricle diastolic dysfunction and found negative correlation between BNP levels and duration of exercise, AT VO 2 , and MET on CPET.…”

“…Am -late diastolic wave during atrial contraction; AT -anaerobic threshold; CPETcardiopulmonary exercise test; COPD -chronic obstructive pulmonary disease; Em -early diastolic wave; FEF 25-75 % -forced expiratory flow at 25-75%; FEV1 -forced expiratory volume at 1 second; FVC -forced vital capacity; IC -inspiratory capacity; MVV -maximum voluntary ventilation; NT-pro BNP -N-terminal of pro B-type natriuretic peptide; PAP -pulmonary arterial pressure; PET CO 2 -partial pressure of end-tidal carbon dioxide; PVCO 2 -peak CO2 output, PVO 2 -peak oxygen uptake; RA diameter -right atrium diameter; RV diameter -right ventricle diameter; RV EF -right ventricle ejection fraction; RV -residuel volume; SF-36 -short form-36; TAPSE -tricuspid annular plane systolic excursion; TLC -total lung capacity; VCvital capacity; VECO 2 -ventilatory equivalent for CO 2 patient and control groups (2.26±0.46 cm; 2.64±0.38 cm respectively, p=0.040). Moreover COPD patients had reduced right ventricular Em wave, Em/Am ratio and tricuspit E wave (Table 2).…”

“…Diastolic dysfunction is defined as inconvenient increase in right ventricle diastolic pressure with insufficient filling of right ventricle. Right ventricular dysfunction can be seen before the development of pulmonary hypertension and cor pulmonale in COPD patients (2)(3)(4).…”

Feasibility of Real-Time Three-Dimensional Echocardiography for the Assessment of Distorted Biventricular Systolic Function in Patients with Cor Pulmonale

“…When pulmonary hypertension progresses, the RV dilates in both end-diastolic and end-systolic volumes. Cor pulmonale leads to changes in RV and LV structures or functions caused by pulmonary hypertension associated with the involvement of the lung or its vasculature 2-6)24-26). There are few studies in which cardiac volumes and functions of patient with cor pulmonale are assessed by RT3DE.…”