Left ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease as a step forward in cardiovascular comorbidome

Abstract

Background Chronic obstructive pulmonary disease (COPD) augments the likelihood of having left ventricular diastolic dysfunction (LVDD) – precursor of heart failure with preserved ejection fraction (HFpEF). LVDD shares overlapping symptomatology (cough and dyspnea) with COPD. Purpose Our aim was to evaluate the predictive value of inflammatory, oxidative stress, cardio-pulmonary and echocardiographic parameters at rest for the diagnosis of stress LVDD in non-severe COPD patients, who complain of exertional dyspnea and are free of overt cardiovascular diseases. Methods A total of 104 COPD patients underwent echocardiography before cardio-pulmonary exercise testing (CPET) and 1–2 minutes after peak exercise. Patients were divided into two groups based on peak E/e': patients with stress induced left ventricular diastolic dysfunction (LVDD) - E/e' >15 (HFpEF) and patients LVDD (without HFpEF). CPET and echocardiographic parameters at rest were measured and their predictive value for stress E/e' was analysed. Markers for inflammation (resistin, prostaglandine E2) and oxidative stress (8-isoprostanes) were also determined. Results Stress induced LVDD occurred in 67/104 patients (64%). Those patients had lower work load, lower VO2 consumption, lower minute ventilation and higher VE/VCO2 slope in comparison to patients without. Except for prostglandine E2, none of the inflammatory, oxidative stress markers correlated to stress E/e'. The best independent predictors for HFpEF were RAVI, right ventricular parasternal diameter and RV E/A >0.75. Their combination predicted HFpEF with the accuracy of 91.2%. Conclusion There is a high prevalence of HFpEF in non-severe COPD with exertional dyspnea, free of overt cardiovascular disease. RAVI, right ventricular parasternal diameter and RV E/A >0.75 were the only independent clinical predictors of HFpEF. FUNDunding Acknowledgement Type of funding sources: None.

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