Echocardiographic Evaluation of Right Ventricular Systolic Function and Right Ventricle–Pulmonary Artery Coupling In Patients With Chronic Obstructive Pulmonary Disease
Resumo
Abstract
Chronic obstructive pulmonary disease (COPD), in addition to causing airflow limitation, is associated with cardiovascular changes, including right ventricular (RV) dysfunction due to increased pressure resistance in the pulmonary circulation. This study aimed to assess RV function in patients with COPD using echocardiographic indices of systolic function and a non-invasive measurement of ventriculo-arterial coupling, as well as its association with functional outcomes. it was a transversal observational study. The study included patients who had spirometric diagnosis of COPD. Fifty-eight patients participated in the study (53.4% male, n = 31) mean age 65 years (SD = 8.7). Tricuspid annular plane systolic excursion (TAPSE), RV tissue S’ wave velocity and TAPSE/PSAP (pulmonary artery systolic pressure) were significantly impaired according to degree of airflow obstruction progression [p = 0.01; p = 0.02, and p = 0.03], respectively. There was significantly lower predicted forced Expiratory Volume in one second (FEV1) compared with the occurrence of two or more abnormal index of RV function versus one or no abnormality (36.4 vs 49.7; p = 0.02). The mean value for TAPSE/PSAP was 0.82 mm/mmHg. RV systolic function impairment was present in a significant proportion of COPD patients despite no clinical suspicion. Lower values of noninvasively determined RVPA coupling were related with lower predicted FEV1 and worse clinical status and can be a promising tool for the estimation of RV deterioration in COPD patients.
Keywords: Pulmonary Disease, Chronic Obstructive. Right Ventricular-Arterial Coupling. Echocardiography.
Resumo
A doença pulmonar obstrutiva crônica (DPOC), além de causar limitação ao fluxo aéreo, está associada a alterações cardiovasculares, incluindo disfunção do ventrículo direito (VD) devido ao aumento da resistência na circulação pulmonar. O objetivo deste estudo foi avaliar a função do ventrículo direito (VD) em pacientes com DPOC, utilizando índices ecocardiográficos de função sistólica e medida não invasiva do acoplamento ventrículo-arterial, bem como sua associação com repercussões funcionais. Estudo observacional transversal. O estudo incluiu pacientes que tinham diagnóstico espirométrico de DPOC. Cinquenta e oito pacientes participaram do estudo (53,4% do sexo masculino, n = 31) com média de idade de 65 anos (DP = 8,7). A excursão sistólica do plano anular tricúspide (TAPSE), a velocidade da onda S' do tecido do VD e a TAPSE/PSAP (pressão sistólica da artéria pulmonar) foram significativamente prejudicadas de acordo com o grau de progressão da obstrução ao fluxo aéreo [p = 0,01; p = 0,02, e p = 0,03], respectivamente. O volume expiratório forçado previsto em um segundo (FEV1) foi significativamente menor em comparação com a ocorrência de dois ou mais índices anormais da função do VD em comparação com uma ou nenhuma anormalidade (36,4 vs 49,7; p = 0,02). O valor médio para TAPSE/PSAP foi 0,82 mm/mmHg. O comprometimento da função sistólica do VD estava presente em uma proporção significativa de pacientes com DPOC, apesar da ausência de suspeita clínica. Os valores mais baixos do acoplamento VD-AP determinado de forma não invasiva foram relacionados a um FEV1 previsto mais baixo e a um pior estado clínico e podem ser uma ferramenta promissora para a estimativa da deterioração do VD em pacientes com DPOC.
Palavras-chave: Doença Pulmonar Obstrutiva Crônica. Acoplamento Ventricular Direitoarterial. Ecocardiografia
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