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It was shown that cardiac function is impaired in chronic obstructive pulmonary disease (COPD) patients who have severe pulmonary hypertension (PHT). However, no previous reports have evaluated cardiac function in COPD patients before and after medical therapy for acute COPD exacerbation. In this study, we evaluated the cardiac function of COPD patients during acute COPD exacerbation.Thirty-two patients (27 men and 5 women; mean age 59 ± 8.7 years) with acute COPD exacerbation without PHT were included in the study. Thirty-two age- and sex-matched control subjects (22 men and 10 women; mean age 57 ± 10 years) were also examined. Right ventricular (RV) and left ventricular (LV) functions were assessed using both conventional and tissue Doppler imaging methods before and after therapy, which were performed according to accepted guidelines. Medical therapy included inhaled β2-agonists, inhaled anticholinergic agents, oxygen, systemic corticosteroids, and antibiotics. The systolic tissue Doppler velocity (TSm) in the RV was increased after therapy (13.7 ± 2.4 vs. 14.4 ± 2.4 cm/s, P = 0.027). The function of the RV and LV during diastole was also improved, and pulmonary artery pressures decreased after therapy (34 ± 5.2 vs. 28.2 ± 4.7 mmHg, P < 0.0001). However, there was no change in LV function during systole.We have demonstrated that treatment of patients with acute COPD exacerbation according to guidelines improves not only pulmonary function, but also RV and LV function and PHT.