What is the clinical evidence from this study?

Study design: Observational. Population: Chronic obstructive pulmonary disease (n=124). Intervention: Echocardiography vs. Healthy controls. Primary outcome: Right index of myocardial performance (RIMP) (p=<0.01).

January 1, 2020Open Access

Echocardiographic evaluation of right ventricular function and its role in the prognosis of chronic obstructive pulmonary disease

Q: What are the key findings of this study?

Echocardiographic parameters of right ventricular function were significantly impaired in COPD patients compared to controls, and abnormal baseline RV function predicted clinical deterioration.

Key Result

Echocardiographic parameters of right ventricular function were significantly impaired in COPD patients compared to controls, and abnormal baseline RV function predicted clinical deterioration.

Study Design

Type

Observational (n=124)

Multicenter

Structured PICO

Does echocardiographic evaluation of right ventricular function predict clinical deterioration in patients with stable COPD?

Population

124 subjects (84 patients with stable COPD of varying severity and free of overt cardiovascular disease, and 40 matched healthy controls), mostly aged 51-70 years. Excluded: coronary artery disease, valvular heart disease, hypertension, atrial fibrillation, cardiomyopathies, other lung pathologies, and other causes of pulmonary hypertension.

Intervention

Echocardiographic evaluation of right ventricular (RV) function at rest (including RIMP, TAPSE, FAC, RV basal strain, TDI TASV, RV FWT, RVSP)

Comparator

Healthy matched controls for baseline comparison; patients with normal RV function for prognostic comparison

Outcome

Clinical deterioration at 6 months (composite of death from any cause, hospital admission, deterioration in PFT of at least 1 grade, and reduction of at least 10% in 6MWD)composite

Echocardiographic parameters of right ventricular dysfunction, particularly RIMP and basal strain, are prevalent in stable COPD patients even without pulmonary hypertension and strongly predict medium-term clinical deterioration.

Main Result

Absolute Event Rate: 0.5% vs 0.4%

p-value: p=<0.01

Limitations

Relatively small sample size

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is associated with structural and mechanical changes in the pulmonary vascular bed that increase right ventricular (RV) afterload and subsequently right heart failure. Objectives: The aim of the study was to elucidate RV dysfunction at rest by echocardiography in a cohort of COPD patients and to study its impact on prognosis. Methods: 84 patients of COPD and 40 matching healthy controls were evaluated at baseline. Evaluation included clinical examination, pulmonary function tests; 6 minutes walk test and echocardiography. Patient with COPD were again evaluated after 6 months. Results: All echocardiographic parameters of RV function were significantly impaired in COPD patients as compared to controls. Clinical deterioration in COPD group was much more in patients with baseline abnormal RV function (89%) and patients with RV systolic pressure ≥35 mmHg (P = 0.018). All the six patients who died had three or more abnormal RV systolic function parameters. Conclusions: RV myocardial performance index and basal strain showed largest difference between controls and COPD cases. Clinical deterioration was more common in patients with abnormal RV function parameters and pulmonary hypertension.

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