Quantitative Left Ventricular Cineangiography in Patients with Chronic Obstructive Pulmonary Disease
LYNN C. CHRISTIANSON, M.D ANILKUMAR SHAH, M.D. VINCENT J. FISHER, M.D. New York, New York
From the Cardiopulmonary Laboratory, Medical Service, Veterans Administration Hospital, and Departments of Medicine and Physiology, New York University School of Medicine, New York. New York. This paper was supported by the Medical Research Service of the Veterans Administration. Requests for reprints should be addressed to Dr. Lynn C. Christianson, Cardiopulmonary Laboratory, Veterans Administration Hospital, First Avenue at 24th Street, New York, NY 10010. Manuscript accepted October 23, 1978.
Using quantitative measurements from cineangiograms, left ventricular function was evaluated in 19 patients with disabling COPD, 10 without and nine with previous right-sided heart failure. None had clinical evidence of diseases known to affect left ventricular function. Severity of airway obstruction was similar in patients without and with prior right-sided heart failure, but hypoxemia and pulmonary hypertension were significantly more severe in the latter. Mean resting cardiac index, left ventricular filling pressure and end-diastolic volume were normal in both groups. In 16 patients (10 without and six with prior right-sided heart failure), left ventricular function was clearly normal, as indicated by normal left ventricular wall motion, ejection fraction and mean velocity of circumferential fiber shortening (V&. The remaining three patients had abnormal left ventricular wall motion, ejection fraction and VCF; these abnormalities could probably be attributed to coronary artery disease in two of the three patients but could not be explained in the third. Abnormal left ventricular function could not be correlated with the severity of COPD, hypoxemia or pulmonary hypertension. Left ventricular wall thickness and mass were normal in all, except for minimal increases in one patient without and one with prior rightsided heart failure. There are no previous reports of quantitative left ventricular cineangiography in patients with COPD, but our results are similar to those reported recently by investigators who measured ejection indices by other methods. It is concluded that a majority of patients with COPD, with or without right-sided heart failure, have normal left ventricular function in the absence of other heart disease. The long-standing controversy regarding left ventricular performance in patients with chronic COPD was sparked by both theoretic considerations and conflicting clinical observatioes. It was argued that the heart, which normally extracts a high percentage of the oxygen presented to it, mostly for development of contractile force, must lose contractility when exposed to hypoxemia. However, normal myocardial oxidative metabolism in men with arterial oxygen tensions (Pao,) as low as 50 torr has been reported [1,2]. It has also been suggested, based on the anatomic relationship of the two ventricles, that the increases in right ventricular size or work, which result from chronic pulmonary hypertension, might affect left ventricular pump function [3]. This possibility now seems less likely since several investigators have reported normal left ventricular ejection fractions in patients with congenital heart lesions that chronically overload the right ventricle [4-61.
March 1979
The American Journal of Medicine
Volume 66
399
QUANTITATIVE LEFT VENTRICULAR CINEANGIOGRAPHY-CHRISTIANSON ET AL.
Comparisonof Clinkal and Hemo~naml~ Characterlstlcs of Patlents Without, and With Previous Right-Sided Heart Failure (RHF)’
TABLE I
Data Patients (no.) Age (yr) FEV, (liters) RV (liters) Paonrest (mm Hg) Paoz exercise Pw, (mm Hsf Hematocrit (% ) TSV (ml/kg)
%Jt Q3,iW H&eat _Hbwclse PPA (mm
P
564~ 1.2 0.8 f 4.4 f 50 f 50 f 54 f 55 f 91 f 3.4 f 4.7 f 91f3 117f9
0.1 0.3 1.7 2.4 2.1 2.1 4.0 0.3 0.5
NS NS NS
LYNN C. CHRISTIANSON, M.D ANILKUMAR SHAH, M.D. VINCENT J. FISHER, M.D. New York, New York
From the Cardiopulmonary Laboratory, Medical Service, Veterans Administration Hospital, and Departments of Medicine and Physiology, New York University School of Medicine, New York. New York. This paper was supported by the Medical Research Service of the Veterans Administration. Requests for reprints should be addressed to Dr. Lynn C. Christianson, Cardiopulmonary Laboratory, Veterans Administration Hospital, First Avenue at 24th Street, New York, NY 10010. Manuscript accepted October 23, 1978.
Using quantitative measurements from cineangiograms, left ventricular function was evaluated in 19 patients with disabling COPD, 10 without and nine with previous right-sided heart failure. None had clinical evidence of diseases known to affect left ventricular function. Severity of airway obstruction was similar in patients without and with prior right-sided heart failure, but hypoxemia and pulmonary hypertension were significantly more severe in the latter. Mean resting cardiac index, left ventricular filling pressure and end-diastolic volume were normal in both groups. In 16 patients (10 without and six with prior right-sided heart failure), left ventricular function was clearly normal, as indicated by normal left ventricular wall motion, ejection fraction and mean velocity of circumferential fiber shortening (V&. The remaining three patients had abnormal left ventricular wall motion, ejection fraction and VCF; these abnormalities could probably be attributed to coronary artery disease in two of the three patients but could not be explained in the third. Abnormal left ventricular function could not be correlated with the severity of COPD, hypoxemia or pulmonary hypertension. Left ventricular wall thickness and mass were normal in all, except for minimal increases in one patient without and one with prior rightsided heart failure. There are no previous reports of quantitative left ventricular cineangiography in patients with COPD, but our results are similar to those reported recently by investigators who measured ejection indices by other methods. It is concluded that a majority of patients with COPD, with or without right-sided heart failure, have normal left ventricular function in the absence of other heart disease. The long-standing controversy regarding left ventricular performance in patients with chronic COPD was sparked by both theoretic considerations and conflicting clinical observatioes. It was argued that the heart, which normally extracts a high percentage of the oxygen presented to it, mostly for development of contractile force, must lose contractility when exposed to hypoxemia. However, normal myocardial oxidative metabolism in men with arterial oxygen tensions (Pao,) as low as 50 torr has been reported [1,2]. It has also been suggested, based on the anatomic relationship of the two ventricles, that the increases in right ventricular size or work, which result from chronic pulmonary hypertension, might affect left ventricular pump function [3]. This possibility now seems less likely since several investigators have reported normal left ventricular ejection fractions in patients with congenital heart lesions that chronically overload the right ventricle [4-61.
March 1979
The American Journal of Medicine
Volume 66
399
QUANTITATIVE LEFT VENTRICULAR CINEANGIOGRAPHY-CHRISTIANSON ET AL.
Comparisonof Clinkal and Hemo~naml~ Characterlstlcs of Patlents Without, and With Previous Right-Sided Heart Failure (RHF)’
TABLE I
Data Patients (no.) Age (yr) FEV, (liters) RV (liters) Paonrest (mm Hg) Paoz exercise Pw, (mm Hsf Hematocrit (% ) TSV (ml/kg)
%Jt Q3,iW H&eat _Hbwclse PPA (mm
P
564~ 1.2 0.8 f 4.4 f 50 f 50 f 54 f 55 f 91 f 3.4 f 4.7 f 91f3 117f9
0.1 0.3 1.7 2.4 2.1 2.1 4.0 0.3 0.5
NS NS NS
