Sub-clinical left and right ventricular dysfunction in patients with COPD

Background: Cardiovascular manifestations in COPD include increased arterial stiffness, ischaemic heart disease, chronic heart failure and cor pulmonale. We hypothesised that sub-clinical right (RV) and left ventricular (LV) dysfunction occurs in patients with COPD, related to the severity of airflow obstruction, arterial stiffness and systemic inflammation. Methods: Thirty six patients and 14 controls, all free of overt cardiovascular disease underwent tissue Doppler echocardiography, spirometry, measurement of aortic pulse wave velocity (PWV) and venous sampling for inflammatory markers. Results: Mean LV myocardial strain and strain rate were less in patients than controls, p < 0.05. LV isovolumic relaxation time (IVRT) was prolonged in patients (125 ± 15.2 ms) compared with controls (98.2 ± 21.1 ms), p < 0.01, indicating LV diastolic dysfunction. The RV free wall strain and strain rate were less in patients than controls, both p < 0.05, indicating RV systolic dysfunction. Patients had sub-clinical pulmonary arterial hypertension with a greater RV myocardial relaxation time and Tei index, both p < 0.01. Patients with mild airways obstruction had LV and RV dysfunction and evidence of increased RV afterload compared with controls. In multivariate analyses aortic PWV predicted LV IVRT, p < 0.01, while FEV₁ predicted RV Tei index and myocardial relaxation time, both p < 0.01. Conclusions: Patients with COPD have sub-clinical left ventricular dysfunction related to arterial stiffness, and right ventricular dysfunction related to airways obstruction. Both right and left ventricular dysfunction are present in patients with mild airways obstruction suggesting that cardiac co-morbidities commence early in the development of COPD.