LEFT VENTRICULAR DYSFUNCTION IN COPD WITH OR WITHOUT COR PULMONALE

BACKGROUND \nChronic Obstructive Pulmonary Disease (COPD) is a disease state characterised by the presence of airflow obstruction due to \nchronic bronchitis or emphysema, which is progressive and partially reversible. Right ventricular failure (cor pulmonale) is a \nwell-known complication of COPD. But, it also involves left ventricle leading to systolic as well as diastolic dysfunction, which \nmaybe present with associated RV failure and also as a separate entity. Diastolic dysfunction is due to defective filling of the \nleft ventricle because of the hyperinflated lung. On the other hand, systolic dysfunction maybe secondary to RV failure due to \nthe effects of hypoxia in the cardiac muscle fibres as a part of the systemic hypoxaemia or it may be due to the effects of the \ncirculatory inflammatory mediators leading to atherosclerosis and ischaemia of cardiac muscles. \nMATERIALS AND METHODS \nIt was a prospective study of 100 patients of COPD classified according to GOLD criteria with or without cor pulmonale admitted \nto our hospital in the period of January 2014 to October 2015 meeting our inclusion and exclusion criteria. Investigations like \nchest x-ray, spirometry, 2D-echocardiography and electrocardiography were done and data was collected. Data were pooled \nand interpreted using standard statistical methods. \nRESULTS \nPrevalence of COPD was common after middle age, the peak being around 5th and 6 \nth decade of life without much gender \ninequality. Cor pulmonale was found in 65% patients of COPD, of which more number were in the severe COPD. LV systolic \ndysfunction was found in 44% of all COPD patients and LV diastolic dysfunction was found in 59% of cases. LV diastolic \ndysfunction was found in 64% and LV systolic dysfunction was found in 49% of patients of COPD with cor pulmonale. LV systolic \ndysfunction was found in 62% of COPD patients who showed a resting hypoxaemia (SpO2 <90%). \nCONCLUSION \nIn our study of 100 COPD patients, we found LV diastolic dysfunction in more than half of patients of moderate and severe \nstages of COPD. LV systolic dysfunction was found in more than one-third of the patients of COPD. So, though cor pulmonale \nis a frequent complication of COPD, assessment of LV function and diagnosing LV dysfunction early in the course is equally \nimportant. Hence, we strongly recommend for routine echocardiography in all patients of COPD especially of severe grades for \nevaluation of LV function, which will reduce the morbidity and mortality and also can improve the quality of life. \n