Determination of the most informative indicators of right-ventricular dysfunction in patients with chronic obstructive pulmonary disease

Abstract

The aim of the article was the evaluation of structural and functional indicators that reflect the nature of right heart remodeling in patients with chronic obstructive pulmonary disease (COPD) in order to identify the most informative indicators of right ventricular heart dysfunction. The study included 60 patients, who were on inpatient treatment. Patients were divided into two groups: I — study group with COPD (n = 30), and II — control group — patients of comparable age without COPD (n = 30). During hospitalization, all patients underwent ECHO-KG with an emphasis on evaluating the systolic-diastolic parameters of the right ventricle. Criteria for inclusion in the study: age over 50 years, presence of COPD, signed informed consent when reading the terms of the study. Exclusion criteria: history/course of neoplastic or hematological disease, systemic connective tissue diseases, documented ischemic disease, valvular heart disease, interstitial lung disease, bronchial asthma. When comparing echocardiographic indicators of right ventricular (RV) function detected significant decrease of systolic function the RV — TAPSE (16.64 ± 4.0 vs 23.21 ± 2.31; p = 0.043), S’(12.57 ± 1.87 vs. 14.96 ± 1.09; p = 0.026), estimated RV EF (49.27 ± 9.23 vs 66.12 ± 7.42; p = 0.021), EFSRV (55.58 ± 7.16 vs 72.4 ± 13.06; p = 0.01) and higher rates SDLA (49.55 ± 6.0 vs 27.1 ± 5.29; p = 0.023) in the study group 1. Measure of right ventricular arterial pairing TAPSE/SDLA was significantly reduced compared with the control group (0.36 ± 0.05 vs 0.86 ± 0.14; p = 0.01). In the main 1 group of patients with COPD, there was a tendency increase of the myocardial performance index (TEI index) (0.76 ± 0.42 vs 0.59 ± 0.22; p = 0.43), which is probably associated with a violation of the relaxation of the right ventricle. To confirm the presence of diastolic RV dysfunction in patients with COPD (in comparison with the control group) revealed significant changes in the indicators obtained from transtricuspid flow — E/Atk (0.67 ± 0.02 vs 1.5 ± 0.38; p = 0.016). The dynamics of the degree of severity of right ventricular dysfunction, estimated using the proposed indicators, may be another additional characteristic of the success of therapy to achieve disease control in patients with COPD.