Echocardiographic predictors of exercise capacity and mortality in chronic obstructive pulmonary disease

BMC Cardiovascular Disorders

Kasper Karmark Iversen³  Ida Steffensen²  Sidse Graff Jensen²  Dorte Moesby²  Jesper Kjærgaard¹  Morten Dalsgaard³  Mikkel Malby Schoos³ 

[1] Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Blegdamsvej 9, 2100 Copenhagen,Denmark;Department of Pulmonary and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark;Department of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark

关键词: Global longitudinal strain;    Tissue doppler;    Diastolic dysfunction;    Systolic dysfunction;    Pulmonary artery pressure;    Exercise capacity;    6MWD;    COPD;   

Others  :  856799
DOI  :  10.1186/1471-2261-13-84

 received in 2013-07-11, accepted in 2013-10-10,  发布年份 2013

【 摘 要 】

Background

Chronic obstructive pulmonary disease (COPD) reduces exercise capacity, but lung function parameters do not fully explain functional class and lung-heart interaction could be the explanation. We evaluated echocardiographic predictors of mortality and six minutes walking distance (6MWD), a marker for quality of life and mortality in COPD.

Methods

Ninety COPD patients (GOLD criteria) were evaluated by body plethysmography, 6MWD and advanced echocardiography parameters (pulsed wave tissue Doppler and speckle tracking).

Results

Mean 6MWD was 403 (± 113) meters. All 90 subjects had preserved left ventricular (LV) ejection fraction 64.3% ± 8.6%. Stroke volume decreased while heart rate increased with COPD severity and hyperinflation. In 66% of patients, some degree of diastolic dysfunction was present. Mitral tissue Doppler data in COPD could be interpreted as a sign of low LV preload and not necessarily an intrinsic impairment in LV relaxation/compliance. Tricuspid regurgitation (TR) increased with COPD severity and hyperinflation. Age (p < 0.001), BMI (p < 0.001), DLCO SB (p < 0.001) and TR (p 0.005) were independent predictors of 6MWD and a multivariable model incorporating heart function parameters (adjusted r² = .511) compared well to a model with lung function parameters alone (adjusted r² = .475). LV global longitudinal strain (p = 0.034) was the only independent predictor of mortality among all baseline, body plethysmographic and echocardiographic variables.

Conclusions

Among subjects with moderate to severe COPD and normal LVEF, GLS independently predicted all-cause mortality. Exercise tolerance correlated with standard lung function parameters only in univariate models; in subsequent models including echocardiographic parameters, longer 6MWD correlated independently with milder TR, better DLCO SB, younger age and lower BMI. We extended the evidence on COPD affecting cardiac chamber volumes, LV preload, heart rate, as well as systolic and diastolic function. Our results highlight lung-heart interaction and the necessity of cardiac evaluation in COPD.

【 授权许可】

   
2013 Schoos et al.; licensee BioMed Central Ltd.

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