Evaluation of echocardiographic parameters for right heart function and pulmonary hypertension in the progression of Chronic Obstructive Pulmonary Disease

Abstract

INTRODUCTION Chronic opstructive pulmonary disease (COPD) is one of the diseases with highest mortality rate, high morbidity and early mortality. Right ventricular hypertrophy with preserved systolic function is most common finding in patients with COPD.COPD patients not so rarely have increased pulmonary vascular resistance (PVR), moderate to severe form of pulmonary hypertension, ‘’cor pulmonale” and right heart failure. Our study investigated the echocardiographic parameters used to assess right ventricular function and pulmonary hypertension in patients with chronic obstructive pulmonary disease (COPD) according to their specificity and sensitivity and disease progression.

MATERIAL AND METHODS We have analysed 94 patients with COPD (Gold class I-IV). The 13 echo-cardiography parameters important for assessment of right ventricular function and pulmonary hypertension due to their sensitivity and specificity and progression of the disease were evaluated: basal dimension of the right ventricle(DV bazal), right atrium(DA), right atrial area(DA area), S‘wave of the right ventricle of TDI, TAPSE, functional area change (FAC %), (SPAP), Vmax of tricuspid regurgitation , acceleration time of pulmonary artery (AT), pulmonary vascular resistance (PVR), myocardial performance index of the right venricle (MPI), global strain of the right ventricle(GL strain), collаpsibility of vena.cava inferior >/<50 %.

RESULTS AND DISCUSSION Predictors of disease progression with high specifity ans sensitivity are the parameters: MPI DV TDI, Global strain of DV and collabsibility of v.cava inferior less then 50%. Predictors of disease progression with high specifity and low sensitivity are : DV bazal, DA, DA area, S TDI, TAPSE, FAC, SPAP, V max TR. Predictors of disease progression with low specifity and high sensistivity are parameters: shortened acceleration time of the pulse Dopler of the pulmonary valve and the development of pulmonary vascular resistаnce.

CONCLUSION Echocardiography is a non invasive and useful method for evaluation and follow up the patients with COPD. All this indicates that the values of certain echocardiographic parameters can help us detect disease progression, with high sensitivity, high specificity or both.