Abstract

ECHOCARDIOGRAPHIC EVALUATION OF RIGHT VENTRICLE IN DIFFERENT STAGES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND ITS CORRELATION WITH SEVERITY OF THE DISEASE

Dr. Indira Ghosh*, Dr. Ashmita Chakraborty, Prof. Dr. Anil Baran Singha Mahapatra,

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disease of the lung characterized by chronic bronchitis, airway thickening and emphysema. COPD has significant cardiac complications also. Development of secondary pulmonary arterial hypertension (PAH) in COPD is associated with an increased risk of acute severe exacerbation. Pulmonary hypertension progressively leads to right ventricular hypertrophy and dilatation with subsequent RV failure. Aims and objectives: The purpose of our study was to evaluate the right ventricular functions in different stages of COPD by echocardiography and to find out it‟s correlation with the severity of the disease. Materials and Methods: We performed an observational and cross-sectional study on 60 COPD patients in R G Kar Medical College, Kolkata. We classified the patients into mild, moderate, severe and very severe COPD according to the GOLD criteria[1], based on their spirometric parameters. Then we have subjected them to 2D echocardiography to evaluate their right ventricular function. For that we focussed on the parameters like RV basal and longitudinal diameters, RV wall thickness, TAPSE (Tricuspid Annular Plane Systolic Excursion), FAC (Fractional Area Change), RIMP (Right ventricular index of myocardial performance) and SPAP (Systolic Pulmonary Arterial Pressure). Results: RV wall thickness was progressively increased from mild to very severe COPD with a significant p value of 0.002. In our study SPAP has been increased significantly from mild to very severe COPD (p=0.001). The mean values of SPAP are 14.05(±3.48) mmHg in mild, 16.80 (±4.52) mmHg in moderate, 21.55(±6.07) mmHg in severe and 29.075(±7.8) mmHg in very severe COPD. Other findings suggestive of RV systolic function also showed progressively decreased values alone with the severity of the disease. Conclusion: Though the elevation of pulmonary arterial pressure in COPD is moderate, but its early detection is helpful to prevent right heart failure. Echocardiography can be used as a screening method for early detection of pulmonary hypertension in COPD before undertaking other invasive and complicated procedures.

Keywords: Chronic obstructive pulmonary disease (COPD), Right ventricle (RV), Echocardiography, Systolic Pulmonary Arterial Pressure (SPAP).