학술논문
Echocardiographic predictors for stress induced right ventricular diastolic dysfunction in non-severe chronic obstructive pulmonary disease
Document Type
Academic Journal
Author
Source
Bulgarian Cardiology. October 9, 2020 Issue 3, p65, 9 p.
Subject
Language
English
ISSN
1310-7488
Abstract
Author(s): Zheyna Cherneva (corresponding author) [1]; Radostina Cherneva [2] Author Note(s): Corresponding author: Zheyna Cherneva (jenicherneva@yahoo.com). Academic editor: Elena Kinova DOI: [...]
Background: Pulmonary vasculopathy, right heart structural and functional abnormalities occur even in normoxemic chronic obstructive pulmonary disease patients. Despite of being associated with functional limitation, exacerbations and disease progression, their detection and proper management is still delayed. Aim: Our aim was to establish the frequency of stress induced right ventricular diastolic dysfunction (RVDD) in non-severe COPD patients, free of clinically overt cardiovascular diseases (ischaemic heart disease, heart failure, uncontrolled arterial hypertension), who complain of exertional dyspnea and to look for echocardiographic predictors of it. Materials and method: We applied cardio-pulmonary exercise testing (CPET) in 104 non-severe, COPD patients. A ramp protocol was performed. Echocardiography was done before and 1-2 minutes after peak exercise. Cut-off values for stress induced RVDD were right ventricular (RV) E/e' ratio > 6, measured by PWD of the tricuspid valve. Receiver operating curves were constructed for echo parameters at rest to determine if any of them may discriminate stress induced RV E/e' > 6 or 20.55 ml/m2; sensitivity - 86%; speciï¬ city - 86%), RVWT (cut-off > 5.25 mm; sensitivity - 100%; speciï¬ city - 63%) and RV E/A ratio at rest (cut-off > 1.05; sensitivity - 79.7%; speciï¬ city - 90.5%) were the best predictors of stress RV E/e. In univariate regression analysis RV E/A showed the highest OR 19.73; (95% CI - 18.52-21.01); followed by RAVI - OR 3.82; (95% CI - 2.04-7.14). Conclusion: There is a high prevalence of stress induced RVDD in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. RAVI, RVWT, RV E/A and RV E/e' ratio at rest may be used as predictors for stress RVDD and may facilitate patients' risk stratiï¬ cation and proper management.
Background: Pulmonary vasculopathy, right heart structural and functional abnormalities occur even in normoxemic chronic obstructive pulmonary disease patients. Despite of being associated with functional limitation, exacerbations and disease progression, their detection and proper management is still delayed. Aim: Our aim was to establish the frequency of stress induced right ventricular diastolic dysfunction (RVDD) in non-severe COPD patients, free of clinically overt cardiovascular diseases (ischaemic heart disease, heart failure, uncontrolled arterial hypertension), who complain of exertional dyspnea and to look for echocardiographic predictors of it. Materials and method: We applied cardio-pulmonary exercise testing (CPET) in 104 non-severe, COPD patients. A ramp protocol was performed. Echocardiography was done before and 1-2 minutes after peak exercise. Cut-off values for stress induced RVDD were right ventricular (RV) E/e' ratio > 6, measured by PWD of the tricuspid valve. Receiver operating curves were constructed for echo parameters at rest to determine if any of them may discriminate stress induced RV E/e' > 6 or 20.55 ml/m2; sensitivity - 86%; speciï¬ city - 86%), RVWT (cut-off > 5.25 mm; sensitivity - 100%; speciï¬ city - 63%) and RV E/A ratio at rest (cut-off > 1.05; sensitivity - 79.7%; speciï¬ city - 90.5%) were the best predictors of stress RV E/e. In univariate regression analysis RV E/A showed the highest OR 19.73; (95% CI - 18.52-21.01); followed by RAVI - OR 3.82; (95% CI - 2.04-7.14). Conclusion: There is a high prevalence of stress induced RVDD in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. RAVI, RVWT, RV E/A and RV E/e' ratio at rest may be used as predictors for stress RVDD and may facilitate patients' risk stratiï¬ cation and proper management.