Original article Herz 2013 DOI 10.1007/s00059-013-3978-9 Received: 13 June 2013 Revised: 8 July 2013 Accepted: 8 August 2013 © Urban & Vogel 2013
B. Geyik1 · N. Tarakci2 · O. Ozeke3 · C. Ertan4 · M. Gul3 · S. Topaloglu3 · D. Aras3 · A.D. Demir4 · O. Tufekcioglu3 · Z. Golbasi3 · S. Aydogdu3 1 Department of Cardiology, Trakya University, Edirne 2 Department of Chest Disease, Acibadem University, Eskisehir 3 Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Kardiyoloji Klinigi, Ankara 4 Department of Cardiology, Acibadem University, Eskisehir
Right ventricular outflow tract function in chronic obstructive pulmonary disease
Additional material online This article includes two additional videos. You will find this supplemental at dx.doi. org/10.1007/s00059-013-3978-9. The abstract section of this study was presented at the 29th Annual Congress of the Turkish Society of Cardiology (26–29 October 2013, Antalya, Turkey).
The right ventricle plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease. However, assessing right ventricular (RV) function is a challenge because of the right ventricle’s complex geometry, its interrelationship with the left ventricle, its extreme sensitivity to loading conditions and to alterations in pulmonary pressure, and a limited understanding of the underlying mechanisms of right heart failure [1, 2]. Due to its widespread availability, echocardiography is used as the first-line imaging modality for assessment of RV size and function; however, a single widely accepted and generally applicable index of RV function is not available [1, 3]. The right ventricle has three distinct features—the“inflow,”“trabeculated apical,” and“outflow tract” (infundibulum or conus) compartments— which contribute to the overall systolic function to different extents [4, 5, 6] (Videos 1 and 2). Although the inlet part of the right ventricle has a
greater contribution to overall RV function compared with the infundibulum [7, 8, 9], some studies have reported the possibility of using right ventricular outflow tract (RVOT) movement or contraction as a marker of RV systolic function [10, 11, 12]. Chronic obstructive pulmonary disease (COPD) is often associated with changes of the structure and the function of the right ventricle; therefore, we aimed to evaluate the role of the RVOT size and function by transthoracic echocardiography in patients with COPD.
Patients and methods We prospectively investigated consecutive COPD male patients and compared them with a control group consisting of age- and sex-matched, healthy, nonsmoking male subjects having normal spirometry test results and no history of infection in the preceding 1 month. All patients gave their written consent to participate in this study. All patients with tachycardia, arrhythmia, infectious disorders, malignant tumors, head and neck abnormalities, ischemic heart disease, and cardiac disorders that cause pulmonary hypertension (e.g., tricuspid valve disorder, left ventricular dysfunction) were excluded. A diagnosis of COPD was made by review of the patient’s history, physical examination, and pulmonary functional tests according to the diagnostic criteria of the Global Initiative (GOLD) for COPD [13].
Pulmonary function tests were performed by spirometry using the MIR Spirolab III. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured and results were given as the percent of predicted values calculated from the reference values reported by the European Community for Coal and Steel [14]. Patients were divided into three groups according to their New York Heart Association (NYHA) functional classification (NYHA class I, no symptoms with ordinary activity; NYHA class II, mild limitation of physical activity and symptoms with ordinary physical activity; NYHA class III, marked limitation of physical activity and symptoms with less than ordinary physical activity; and NYHA class IV, symptoms with any physical activity or at rest). Echocardiographic analysis was performed by the same echocardiographer on the same day as spirometry. Patients had not suffered an exacerbation of COPD for at least 1 month prior to echocardiography. Transthoracic echocardiography was performed by using a GE Vivid S5 with a 3.0-MHz phased-array transducer. Patients were examined in the left lateral decubitus position. The pulmonary artery systolic pressure (SPAP) was estimated by continuous wave Doppler evaluation of tricuspid regurgitation [15, 16]. Pulmonary valve Doppler flow velocities were recorded from the parasternal short-axis view using the Herz 2013
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Original article capacity (r=−0.589, p
B. Geyik1 · N. Tarakci2 · O. Ozeke3 · C. Ertan4 · M. Gul3 · S. Topaloglu3 · D. Aras3 · A.D. Demir4 · O. Tufekcioglu3 · Z. Golbasi3 · S. Aydogdu3 1 Department of Cardiology, Trakya University, Edirne 2 Department of Chest Disease, Acibadem University, Eskisehir 3 Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Kardiyoloji Klinigi, Ankara 4 Department of Cardiology, Acibadem University, Eskisehir
Right ventricular outflow tract function in chronic obstructive pulmonary disease
Additional material online This article includes two additional videos. You will find this supplemental at dx.doi. org/10.1007/s00059-013-3978-9. The abstract section of this study was presented at the 29th Annual Congress of the Turkish Society of Cardiology (26–29 October 2013, Antalya, Turkey).
The right ventricle plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease. However, assessing right ventricular (RV) function is a challenge because of the right ventricle’s complex geometry, its interrelationship with the left ventricle, its extreme sensitivity to loading conditions and to alterations in pulmonary pressure, and a limited understanding of the underlying mechanisms of right heart failure [1, 2]. Due to its widespread availability, echocardiography is used as the first-line imaging modality for assessment of RV size and function; however, a single widely accepted and generally applicable index of RV function is not available [1, 3]. The right ventricle has three distinct features—the“inflow,”“trabeculated apical,” and“outflow tract” (infundibulum or conus) compartments— which contribute to the overall systolic function to different extents [4, 5, 6] (Videos 1 and 2). Although the inlet part of the right ventricle has a
greater contribution to overall RV function compared with the infundibulum [7, 8, 9], some studies have reported the possibility of using right ventricular outflow tract (RVOT) movement or contraction as a marker of RV systolic function [10, 11, 12]. Chronic obstructive pulmonary disease (COPD) is often associated with changes of the structure and the function of the right ventricle; therefore, we aimed to evaluate the role of the RVOT size and function by transthoracic echocardiography in patients with COPD.
Patients and methods We prospectively investigated consecutive COPD male patients and compared them with a control group consisting of age- and sex-matched, healthy, nonsmoking male subjects having normal spirometry test results and no history of infection in the preceding 1 month. All patients gave their written consent to participate in this study. All patients with tachycardia, arrhythmia, infectious disorders, malignant tumors, head and neck abnormalities, ischemic heart disease, and cardiac disorders that cause pulmonary hypertension (e.g., tricuspid valve disorder, left ventricular dysfunction) were excluded. A diagnosis of COPD was made by review of the patient’s history, physical examination, and pulmonary functional tests according to the diagnostic criteria of the Global Initiative (GOLD) for COPD [13].
Pulmonary function tests were performed by spirometry using the MIR Spirolab III. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured and results were given as the percent of predicted values calculated from the reference values reported by the European Community for Coal and Steel [14]. Patients were divided into three groups according to their New York Heart Association (NYHA) functional classification (NYHA class I, no symptoms with ordinary activity; NYHA class II, mild limitation of physical activity and symptoms with ordinary physical activity; NYHA class III, marked limitation of physical activity and symptoms with less than ordinary physical activity; and NYHA class IV, symptoms with any physical activity or at rest). Echocardiographic analysis was performed by the same echocardiographer on the same day as spirometry. Patients had not suffered an exacerbation of COPD for at least 1 month prior to echocardiography. Transthoracic echocardiography was performed by using a GE Vivid S5 with a 3.0-MHz phased-array transducer. Patients were examined in the left lateral decubitus position. The pulmonary artery systolic pressure (SPAP) was estimated by continuous wave Doppler evaluation of tricuspid regurgitation [15, 16]. Pulmonary valve Doppler flow velocities were recorded from the parasternal short-axis view using the Herz 2013
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Original article capacity (r=−0.589, p
