Gupta N K, Agrawal Ritesh Kumar, Srivastav A B, Ved M L
Department of Tuberculosis and Chest Diseases, R N T Medical College, Udaipur, Rajasthan, India.
Lung India. 2011 Apr;28(2):105-9. doi: 10.4103/0970-2113.80321.
Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes.
To assess the cardiac changes secondary to COPD by echocardiography and to find out the correlation between echocardiographic findings and severity of COPD, if there is any.
A total 40 of patients of COPD were selected and staged by pulmonary function test (PFT) and evaluated byechocardiography.
On echocardiographic evaluation of COPD, 50% cases had normal echocardiographic parameters. Measurable tricuspid regurgitation (TR) was observed in 27/40 cases (67.5%). Pulmonary hypertension (PH), which is defined as systolic pulmonary arterial pressure (sPAP)> 30 mmHg was observed in 17/27 (63%) cases in which prevalence of mild, moderate, and severe PH were 10/17 (58.82%), 4/17 (23.53%), and 3/17 (17.65%), respectively. The frequencies of PH in mild, moderate, severe, and very severe COPD were 16.67%, 54.55%, 60.00%, and 83.33%, respectively. Right atrial pressure was 10 mmHg in 82.5% cases and 15 mmHg in 17.5% cases. Cor pulmonale was observed in 7/17 (41.17%) cases; 7.50% cases had left ventricle (LV) systolic dysfunction and 47.5% cases had evidence of LV diastolic dysfunction defined as A ≥ E (peak mitral flow velocity of the early rapid filling wave (E), peak velocity of the late filling wave caused by atrial contraction (A) on mitral valve tracing) Left ventricle hypertrophy was found in 22.5% cases.
Prevalence of PH has a linear relationship with severity of COPD and severe PH is almost associated with cor pulmonale. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions.
慢性阻塞性肺疾病（COPD）对心脏功能有显著影响，包括右心室、左心室和肺血管的功能。与COPD相关的死亡率增加大多归因于心脏受累。超声心动图提供了一种快速、无创、便携且准确的方法来评估心脏变化。
通过超声心动图评估COPD继发的心脏变化，并找出超声心动图结果与COPD严重程度之间的相关性（如果存在的话）。
选取40例COPD患者，通过肺功能测试（PFT）进行分期，并通过超声心动图进行评估。
在对COPD患者进行超声心动图评估时，50%的病例超声心动图参数正常。在40例中的27例（67.5%）观察到可测量的三尖瓣反流（TR）。将收缩期肺动脉压（sPAP）>30 mmHg定义为肺动脉高压（PH），在27例中有17例（63%）观察到PH，其中轻度、中度和重度PH的患病率分别为17例中的10例（58.82%）、4例（23.53%）和3例（17.65%）。轻度、中度、重度和极重度COPD中PH的发生率分别为16.67%、54.55%、60.00%和83.33%。82.5%的病例右心房压力为10 mmHg，17.5%的病例为15 mmHg。在17例中的7例（41.17%）观察到肺心病；7.50%的病例有左心室（LV）收缩功能障碍，47.5%的病例有LV舒张功能障碍的证据，定义为A≥E（二尖瓣早期快速充盈波的峰值流速（E），二尖瓣描记图上由心房收缩引起的晚期充盈波的峰值流速（A））。22.5%的病例发现左心室肥厚。
PH的患病率与COPD的严重程度呈线性关系，重度PH几乎与肺心病相关。超声心动图有助于早期发现COPD病例中的心脏并发症，为早期干预争取时间。
