Chest
Volume 113, Issue 3, March 1998, Pages 576-583
Journal home page for Chest

Clinical Investigations: COPD
Right and Left Ventricular Dysfunction in Patients With Severe Pulmonary Disease

https://doi.org/10.1378/chest.113.3.576Get rights and content

Objective

To determine the prevalence of right and left ventricular dysfunction in a prescreened population of patients with severe pulmonary disease, and to analyze the relationship between right and left ventricular function.

Design

Retrospective record review of 434 patients with severe pulmonary disease.

Patients

Patients with end-stage pulmonary disease, including α1-antitrypsin deficiency emphysema, COPD, cystic fibrosis (CF), idiopathic pulmonary fibrosis, and pulmonary hypertension (primary and Eisenmenger's syndrome), who were evaluated for lung transplantation between January 1993 and December 1995.

Results

Right ventricular dysfunction (right ventricular ejection fraction [RVEF] <45%) was present in 267 patients (66%), but the prevalence was highest (94%) in patients with pulmonary vascular disease. Among the patients with airway or parenchymal lung disease, the prevalence ranged from 59% in COPD to 66% in CF. In contrast, left ventricular dysfunction (left ventricular ejection fraction [LVEF] <45%) was present in only 6.4%, but it, too, was most common in the group with pulmonary hypertension (19.6%). In the groups with parenchymal or airway disease, the prevalence was 3.6%, and there was no statistical difference among the four diagnoses (α1-antitrypsin deficiency emphysema; COPD; CF; idiopathic pulmonary fibrosis). LVEF showed a significant correlation with RVEF (r=0.44; p<0.05), and left ventricular dysfunction was associated with the presence of moderate-to-severe tricuspid regurgitation but not with coronary artery disease. In a subset of patients with both right and left ventricular dysfunction who subsequently underwent lung transplantation, RVEF and LVEF increased pari passu after transplantation.

Conclusion

The prevalence of right ventricular dysfunction is high in patients with end-stage pulmonary disease, but the prevalence of left ventricular dysfunction is relatively low. Left ventricular dysfunction appears to be related to right ventricular dysfunction, perhaps through ventricular interdependence.

Section snippets

Patients

The files of 464 patients with end-stage lung disease who had been evaluated for lung transplantation at Barnes-Jewish Hospital between January 1993 and December 1995, were reviewed. The medical records of all referrals were screened before an on-site evaluation, and standard guidelines were used to identify possible candidates for transplantation.10, 11, 12 Patients with a history of significant coronary artery disease, myocardial infarction, cardiomyopathy, or valvular disease were excluded

Clinical Variables

The study included 434 patients, 237 women and 197 men, with a mean age of 45.7±11.6 years (Table 1). The most common diagnosis was COPD; the other four disease groups were similar in size. Not unexpectedly, the characteristics were somewhat different among the five diagnostic groups. Patients with CF were younger, had a lower mean body weight, and had a higher mean hemoglobin concentration than the other groups. Patients with COPD were the oldest, and patients with IPF were heavier. Female

Discussion

The cardiovascular status of patients with advanced lung disease has not been extensively studied, and the relationship between right ventricular and left ventricular function in this setting remains uncertain. In this study, the prevalence of right and left ventricular dysfunction was determined in a prescreened population with severe pulmonary disease who had been evaluated for lung transplantation. The diseases included the common parenchymal and airway diseases (A1E, COPD, CF, and IPF) and

References (26)

  • MacNeeW

    Right ventricular function in cor pulmonale

    Cardiology

    (1988)
  • McFaddenRE et al.

    Cor pulmonale

  • SongGJ et al.

    Left ventricular dysfunction in obstructive lung disease: an echocardiographic and angiographic study of cor pulmonale patients with decreased mitral E-F slope

    Int J Cardiol

    (1989)
  • Cited by (0)

    View full text