Chest
Volume 94, Issue 6, December 1988, Pages 1169-1175
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Clinical Investigations
Pulmonary Hypertension and Right Ventricular Function in Patients with COPD

https://doi.org/10.1378/chest.94.6.1169Get rights and content

In 100 patients with chronic obstructive pulmonary disease (COPD), we found no significant correlation between simultaneous measurements of right ventricular ejection fraction, using radionuclide ventriculography, and pulmonary arterial pressure. There was, however, a weak but significant correlation between right ventricular ejection fraction and the pulmonary vascular resistance (r = 0.40, p<0.005). In 52 of these patients, 37 with pulmonary hypertension, right ventricular end-systolic volume index was 53 ± 21 ml·m–2 and end-diastolic volume index was 86 ± 27 ml·m–2, compared with a calculated mean of 33 ml·m–2 and 79 ml·m–2, respectively, for normal subjects. In 24 of these patients where the measurements were made at rest and on exercise, the mean right ventricular end-systolic volume increased from 66 ± 20 ml·m–2 to 87 ± 32 ml·m–2, with an increase in right ventricular systolic pressure from 28 ± 9 mm Hg to 55 ± 15 mm Hg. Analysis of the slope of the right ventricular end-systolic pressure volume relationship at rest and on exercise suggested relatively normal right ventricular contractility in the majority of patients. Thus, in these patients with stable COPD, despite the presence of pulmonary hypertension, right ventricular contractility remained relatively normal. (Chest 1988; 94:1169-75)

Section snippets

Patients

One hundred patients were studied (66 men and 34 women, mean age 62, SD eight years) who had a history of cough and sputum production for three months per year for at least two consecutive years. The patients had airflow limitation (FEV1/FVC <60 percent predicted) which was largely irreversible (<15 percent change in FEV1 in response to two puffs of a β−2 agonist), indicating COPD. Most had severe airflow limitation (although we wished to have a wide range of disability), with hypoxemia, but

RESULTS

In these 100 patients with COPD, there was a wide range of ventilatory function, arterial blood gas values, Ppa¯ and RVEF (Table 1). There was no correlation between mean pulmonary arterial pressure and simultaneous measurements of RVEF (Fig 1) (r = –0.07), nor between RVEF and systolic pulmonary arterial pressure (r = –0.02). However, there was a weak but significant correlation between the total pulmonary vascular resistance and the RVEF (r = –0.40, p<0.05, n = 52). In addition, RVEF did

DISCUSSION

We found no correlation between simultaneous measurements of RVEF and the Ppa¯ (Fig 1) in 100 patients with COPD who had a wide range of both Ppa¯ and RVEF (Table 1). This represents the largest group of patients with COPD where a correlation between these simultaneously measured variables has been made. Previous studies have shown correlation coefficients between Ppa¯ and RVEF varying from + 0.23 to –0.86.5, 6, 7, 8, 20, 21, 22, 23, 24 Several factors may account for this

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    Manuscript received February 2; revision accepted April 26.

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