Left Atrial and Ventricular Filling in Chronic Obstructive Pulmonary Disease

Abstract

Abnormal left ventricular (LV) diastolic function has frequently been reported in patients with chronic obstructive pulmonary disease (COPD). In the present work, diastolic function was studied by a combined analysis of pulmonary venous and mitral blood flow velocities in 34 patients with COPD clinically stable and without history of heart disease, and 20 control subjects. We confirmed the increased contribution of the atrial contraction to the LV filling in COPD patients in comparison with control subjects; furthermore, a decreased left atrial (LA) filling during the ventricular systole was observed. Changes in LV filling were not the consequence of a systolic dysfunction, because LV systolic function was normal. Doppler indices indicated that LA pressure was below 15 cm H(2)O in all the patients with COPD and control subjects. Several factors can be put forward to explain these changes; the first one is tachycardia. In addition to hypoxemia and medications, echocardiography suggested that a decreased LV preload participated in increased heart rate. Analysis of Doppler transmitral and pulmonary venous flows demonstrated the role of the ventricular interdependence because a correlation existed between LA and LV filling pattern and right ventricle pressure and diameter.

Assessment of Left and Right Ventricular Functions by Myocardial Performance Index in Patients with Chronic Pulmonary Disease.

“…Lamia et al (118) found that the E wave was significantly lower and the A wave was significantly higher in COPD patients compared to control subjects. The E/A ratio was significantly lower in COPD patients as well as the Em velocity, indicating a LV diastolic dysfunction.…”

Effects of Inhaled Tiotropium on Left Ventricular Diastolic Function in Chronic Obstructive Pulmonary Disease Patients after Pulmonary Resection

“…1) Older age, hypertension, female sex, diabetes, and obesity have been identified as risk factors for LV diastolic dysfunction. 16) However, COPD has not been widely known as a risk factor for LV diastolic dysfunction.…”

“…1) Lung cancer patients with COPD suffer from dyspnea long after pulmonary resection. LV diastolic dysfunction has been associated with dyspnea in heart failure patients with preserved ejection fraction.…”

Estudo da remodelação cardíaca em pacientes com doença pulmonar obstrutiva crônica

“…VS: volume sistólico; PP: pressão de pulso; APTac: tempo de aceleração do fluxo sistólico na artéria pulmonar; AP-Tej: tempo de ejeção do fluxo sistólico na artéria pulmonar; AP-Vmax: pico de velocidade máxima do fluxo sistólico na artéria pulmonar. (Schena et al, 1996;Boussuges et al, 2000;Funk et al, 2008). Em nosso estudo não encontramos evidências de interferência do VD sobre o VE; portanto, outras manifestações sistêmicas da DPOC, como inflamação, não avaliadas no presente estudo, podem ser estar envolvidas na fisiopatologia desta alteração.…”

“…A hipoxemia crônica induz ao remodelamento da árvore vascular pulmonar, o que desencadeia aumento na resistência vascular pulmonar e favorece a instalação de hipertensão pulmonar com subseqüente insuficiência cardíaca direita (cor pulmonale) (Bates et al, 1998;Machado et al, 1999;Weitzenblum, 2003). Mitchell & Filley (1964) Vários estudos mostram as alterações da função ventricular direita em pacientes com DPOC (Palevsky & Fishman, 1990;Schulman & Matthay, 1992;Ota & Pereira, 1998;Vizza et al, 1998;Higham et al, 2001;Hida et al, 2002;Barbera et al, 2003;Weitzenblum, 2003); entretanto, os dados sobre alterações de ventrículo esquerdo (VE) nesses pacientes são controversos (Williams et al, 1968;Render et al, 1995;Schena et al, 1996;Vonk Noordegraaf et al, 1997;Boussuges et al, 2000;Okoshi et al, 2000;Rocha et al, 2004;Vonk-Noordegraaf et al, 2005;Jörgensen et al, 2007a;Funk et al, 2008).…”