In patients with chronic obstructive pulmonary disease (COPD), right ventricle dilation is associated with unfavorable prognostic markers, including more frequent disease exacerbations and worsening of functional capacity. This was among findings of a longitudinal observational study recently published in the journal Heart & Lung.
Investigators in Brazil sought to explore morphological and functional echocardiographic variables associated with COPD exacerbations, pulmonary function parameters, and functional capacity assessment in patients with COPD. The study included individuals with COPD with preserved left ventricle ejection fraction (LVEF >50%) on echocardiogram. Participants’ COPD diagnosis was based on clinical diagnosis (ie, symptoms and positive tobacco exposure) and functional diagnosis (defined by postbronchodilator spirometry parameters — ie, forced expiratory volume in first second of expiration [FEV1]/forced vital capacity [FVC] ratio of <0.7).
All participants underwent clinical assessment, a transthoracic echocardiogram, a prebronchodilator and postbronchodilator spirometry, and a 6-minute walking test (6MWT). The patients were followed for 1 year and evaluated for COPD exacerbations, which were characterized by clinical care assessment with the necessity of bronchodilator optimization, antibiotic use, introduction of systemic corticosteroids, or need for hospitalization.
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A total of 91 patients with COPD were eligible for enrollment. The participants were stratified into 2 groups, based on their basal right ventricle diastolic diameter (RVDD) measuring >35 mm or <35 mm. The mean patient age was 65±7 years. Overall, 55 of the patients were male; 20 were active smokers. The mean BMI was 26±7 kg/m2.
Results of the study showed that participants with an RVDD of >35 mm exhibited significantly worse functional capacity in the 6MWT (P =.05) and more exacerbations of COPD over the 1-year follow-up (P =.05). Significant correlations were noted with respect to greater RVDD vs FVC (P =.02) and distance in the 6MWT (P =.03) in patients who experienced COPD exacerbations.
Through univariate regression analysis, the investigators found that the RVDD was responsible for 55% of the variation in distance in the 6MWT (–0.75 m) in patients with COPD.
A limitation of the current study was the small sample size. An additional limitation was the impossibility, at the moment of data capture, to perform such measures as inspiratory capacity and functional residue capacity in order to assess hyperinflation, study authors noted.
The researchers concluded that the “echocardiogram may be a useful tool to identify patients who need more aggressive strategies to control the evolution of the disease with potential impact in pulmonary rehabilitation.” They added that additional studies are warranted to prospectively investigate echocardiographic variables, including RVDD, as potential predictors of unfavorable outcomes among individuals with COPD.
Reference
Faria RA, Goulart CL, Santos PB, et al. Association of right ventricle diastolic diameter with pulmonary function, exercise tolerance and exacerbation period in patients with chronic obstructive pulmonary disease: a prospective study. Heart Lung. Published online April 12, 2022. doi:10.1016/j.hrtlng.2022.04.003
