Left heart function in chronic obstructive lung disease

Abstract

In patients with varying degrees of chronic obstructive pulmonary disease (COPD), simultaneous measurements of central hemodynamics and left ventricular radionuclide ventriculograms at rest and during exercise were made. In 21 of these patients, satisfactory echocardiograms could be performed. In seven of the patients, arterial blood pressure at rest was increased. Decreased compliance of the left ventricle was thought to be present in patients with COPD and additional arterial hypertension. The left ventricular ejection fraction (LVEF) at rest was in the high normal range in all patients. During exercise, no further increase was observed. This pattern of LVEF response seems to be typical in patients with COPD. Because the highest values were observed in the more severe COPD and right ventricular hypertrophy, it is unlikely that an impairment of left ventricular function is caused by COPD. In five of 27 patients, an abnormal decrease of LVEF and regional hypokinesis occurred during exercise, thus suggesting additional coronary heart disease. The fact that at least 30% of the patients with COPD suffered from arterial hypertension and 20% of the patients exhibited unexpected ischemia detected by regional hypokinesis in RNV during exercise, but not in the ECG, may be of practical relevance. Coronary angiography was not indicated because most of these patients were over 65 and the factor limiting the working capacity was ventilatory impairment and not angina pectoris, in all patients. For this reason, a diagnostic uncertainty remains with regard to additional coronary heart disease in the older patients with advanced chronic obstructive pulmonary disease.

Left Atrial and Ventricular Filling in Chronic Obstructive Pulmonary Disease

“…Changes in the LV filling rate do not seem to be the consequence of a LV systolic dysfunction, because the parameters of LV systolic function were similar in both groups. This result is in agreement with previous findings in patients with COPD (22)(23)(24). Moreover, there was no evidence of LV hypertrophy in our COPD group, which might have explained LV filling abnormality.…”

Heart failure and COPD: Partners in crime?

“…In summary, LVEF seems to be normal in COPD patients without recognized cardiovascular comorbidity 31–37 (Table S4 in the online supporting information). In those with an affected right heart, generally lower but still normal ejection fractions were found 32,34,36,37 …”

“…In a large cohort of stable emphysema patients without a history of cardiovascular disease, mean pulmonary capillary wedge pressure was 14 mm Hg, 35 indicating mild LVDD. Some smaller studies showed no LVDD in comparable patients 32,36,38 (Table S5 in the online supporting information). Boussuges et al .…”

Metabolic and cardiorespiratory effects of decreasing lung hyperinflation with budesonide/formoterol in COPD: a randomized, double-crossover, placebo-controlled, multicenter trial

“…Hyperinflation has been linked to low cardiac output in patients with COPD [10], in part by limiting left ventricular stroke volume [11,12]. Reversing hyperinflation through lung volume reduction surgery improves cardiac function at rest and during exercise [13,14].…”