Ventricular Dysfunction Right

IJCS

Editorial

Advanced Echocardiographic Techniques for the Diagnosis of Subclinical Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a common and treatable disease in the general population, accounting for high morbidity and mortality rates. In patients with severe COPD, hypoxemia is the main cause of complications such as pulmonary hypertension (PH) and right ventricle (RV) dysfunction. However, the presence of RV vascular structural and functional changes may occur in the early stages of COPD, even before significant hypoxemia or PH. Subclinical RV dysfunction often precedes the development of signs and symptoms of RV failure; thus, there is an evident need to detect it from the onset of the disease.

The importance of the RV in cardiovascular physiology has been underestimated for decades. Previously considered a mere conduit, the chamber is now known to play a major role in maintaining global cardiac function intact. Impairment of RV systolic function is an essential determinant of clinical outcomes in different scenarios and should thus be considered in the individualized management of patients.^,

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IJCS

Original Article

Chronic Obstructive Pulmonary Disease: The Role of Myocardial Deformation Indices and Right Ventricle Three-Dimensional Echocardiography

Claudia Myriam Amaral Botelho et al. José Luiz Barros Pena Bruno Rezende Passos Paulo Roberto Latorre Fortes Maria da Consolação Vieira Moreira

Abstract

Background:

Right ventricular dysfunction is a major complication in chronic obstructive pulmonary disease (COPD) and, despite its prognostic implications, is rarely considered in routine clinical analysis.

Objectives:

To compare RV function variables with standard and advanced echocardiographic techniques in patients with stable COPD and controls.

Methods:

Twenty COPD patients classified as GOLD ≥ II (13 men aged 68.4 ± 8.3 years) and 20 matched controls were compared. Myocardial strain/strain rate indices were obtained by tissue Doppler and two-dimensional speckle tracking echocardiography. Right ventricular ejection fraction was obtained with three-dimensional software. Free wall myocardial thickness (FWMT) and tricuspid annular systolic excursion (TAPSE) were also measured. Numerical variables were compared between groups with Student’s t-test or the Mann-Whitney test. Associations between categorical variables were determined with Fisher’s exact test. P-values < 0.05 were considered statistically significant.

Results:

All myocardial deformation indices, particularly global longitudinal strain (-17.2 ± 4.4 vs -21.2: ± 4.4 = 0.001) and 3D right ventricular ejection fraction (40.8 ± 9.3% vs 51.1 ± 6.4% p <0.001) were reduced in COPD patients. These patients presented higher right ventricular FWMT and lower TAPSE values than controls.

Conclusion:

Myocardial deformation indices, either tissue Doppler or speckle tracking echocardiography and 3D right ventricular ejection fraction, are robust markers of right ventricular dysfunction in patients with stable COPD. Assessing global longitudinal strain by speckle tracking echocardiography is a more practical and reproducible method.