Prognostic Significance of Echocardiographic Parameters for Right Heart Assessment and Risk of Developing Advanced Gold Classes in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Abstract

Background: Chronic obstructive pulmonary disease (COPD) аaccording to World Health Organization is the third leading cause for early death and disability in 2022. COPD is characterized by persistent airflow limitation that is typically progressive and associated with an enhanced chronic inflammatory response in the airways and lung tissue. As the disease progresses more cardiovascular complication appear such as right ventricular hypertrophy with preserved systolic function, pulmonary artery pressure (which is slightly to moderately increased), and moderate tricuspid regurgitation.

Material and methods:

The design of our study was a prospective-clinical cross-sectional study. We analyzed 94 patients with COPD. All patients were divided in groups according to degree of obstruction and classified by GOLD classification system into four groups from GOLD 1-GOLD4. In our study all patients during admission and hospital stay were thoroughly examined with anamnesis, physical examination and electrocardiogram (ECG), as well as with basic and advanced echocardiographic assessment.13teen echo parameters were evaluated applying advanced echocardiographic analysis especially in terms of right heart features.

Results:

All echocardiographic parameters were analyzed to understand their significance in disease progression in patients with COPD and increasing Gold classes. Twelve of 13-teen echo-parameters evaluated in our study have quantitative values, while collapsibility of vena cava >50% is a qualitative parameter. Quantitative values of the same echo-parameters (DA, S TDV DV, TAPSE, FAC, AT a.pulmonalis, SPAP, v.max, MPI DV, Stain DV, DA area, PVR and collapsibility of vena cava > 50 %) were compared in terms of Gold classes by multivariate linear regression analysis. With multivariate linear regression analysis, there is a statistically significant correlation (with the following three echocardiographic parameters: S’ TDV DV, DV basal and Global strain DV according to GOLD classes. In further analyses, binary categorization of GOLD classes into two binary categories was additionally used: lower GOLD classes (1 and 2), and more advanced GOLD classes (3 and 4) by applying logistic regression model. The parameter basal dimension of the right ventricle (RV basal) has the highest values statistically, the parameters SPAP, AT a.pulm, Gl strain of DV and TAPSE have somewhat lower values.

Conclusion:

Prevalence of pulmonary hypertension has a linear relationship with severity of COPD and severe pulmonary hypertension is almost every time associated with development of right heart failure. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions. We suggest screening of all COPD patients for cardiac complications using echocardiography as a non-invasive and repeatable for their follow-up