Left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease (COPD), prevalence and association with disease severity: Using tissue Doppler study

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. It has some significant extra pulmonary effects that may contribute to its severity in individual patient. Among COPD patients, cardiovascular diseases (CVD) are responsible for approximately 50% of all hospitalizations and 20% of all deaths. Left ventricular diastolic dysfunction (LVDD) is a frequent condition in COPD patients. Inflammation is considered to be one of the systemic manifestations of COPD and provides an alternative hypothesis to explain the relationship between airflow limitation and cardiovascular risk. The present study aimed to assess the prevalence of LV diastolic dysfunction in COPD patients and its relation to the disease severity and presence of inflammatory markers. Patient and methods: Forty nine (49) COPD patients were included in this study. All patients were subjected to full medical history, physical examination, chest roentgenogram, spirometry, laboratory blood testing for inflammatory mediators (C-reactive protein, matrix metalloproteinase-9 and tissue inhibitor metalloproteinase-1) and Echo Doppler study (conventional and tissue Doppler analysis). Results: The results showed that 36 COPD patients had LVDD (73.3%). There was a good correlation between LVDD parameters and COPD severity across GOLD stages and inflammatory markers. MMP-9 was statistically high in COPD patient with increasing severity with a p-value < 0.0001. Also LVDD parameters were correlated with MMP-9 (p-value < 0.00001). Other inflammatory markers were also correlated to the degree of airway obstruction (FEV1) and presence of LVDD. Conclusion: There is a high prevalence of LVDD in COPD patients which is associated with increased disease severity and associated with high levels of inflammatory markers (serum MMP9 and TIMP-1). It is important to exclude decompensated heart failure during COPD exacerbation. (C) 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of The Egyptian Society of Chest Diseases and Tuberculosis.