P637Early right ventricular systolic dysfunction in patients with COPD without pulmonary hypertension


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Abstract

Background: The aim of this study was to assess right ventricular (RV) systolic function in patients with chronic obstructive pulmonary disease (COPD) without pulmonary hypertension (PH) by isovolumetric acceleration (IVA), tricuspidal annular systolic excursion (TAPSE) and tissue velocity imaging (TVI) as early indexes for detection of RV systolic dysfunction in COPD patients with normal resting pulmonary artery pressure (mPAP).Methods: 36 patients with COPD and mPAP<25mmHg, aged 65.0 years (61.5-70.0), weight 72.0 kg (62.5-79.0), height 170.5 cm (164.0-176.5) and BMI 24.6 (22.0-26.9) [median (25%-75% percentiles] and 17 healthy matched controls with normal estimated non invasive systolic pulmonary artery pressure (sPAP) were included. Systolic function was measured by standard TTE including measurements of IVA, TAPSE and TVI. RV images were obtained at end-expiration from a modified apical four-chamber view to optimize RV visualization. Three consecutive cycles were recorded with a frame rate greater than 150 fps for offline analysis. The region of interest (ROI) for TVI was placed at basal RV free wall. All the COPD patients underwent standard right heart catheterization (RHC) for mean pulmonary artery pressure (mPAP) evaluation, and PH was defined as mPAP rest ≥ 25 mmHg. Controls were evaluated for PH as determined by transtricuspid conventional Doppler echocardiography and estimation of sPAP according to the continuous equation.Results: There were no significant differences in age, weight, height or BMI between the groups. IVA, TAPSE and TVI were significantly reduced in the patient group compared to controls (p<0.05), respectively from 3.2 m/s2 (2.9-3.7) to 1.8 m/s2 (1.6-2.1), 2.8 mm (2.7-3.0) to 2.3 mm (2.1-2.4) and 11.5 cm/s (10.8-12,8) to 8.8 cm/s (8.1-9.9).Conclusion: This study shows that systolic RV function is reduced in COPD patients despite normal mPAP at rest. It is therefore important to evaluate systolic RV function also in COPD patients without established PH, for early detection of right ventricular systolic impairment.

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