左心室舒张功能障碍与慢性阻塞性肺疾病严重程度的关系。
Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease.
机构信息
Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Disciplina de Pneumologia, Botucatu/SP, Brazil.
出版信息
Clinics (Sao Paulo). 2013 Jun;68(6):772-6. doi: 10.6061/clinics/2013(06)08.
OBJECTIVES
The prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease according to disease severity has not yet been established. The aim of this study was to assess the prevalence of electrocardiographic and echocardiographic abnormalities in chronic obstructive pulmonary disease patients according to disease severity.
METHODS
The study included 25 mild/moderate chronic obstructive pulmonary disease patients and 25 severe/very severe chronic obstructive pulmonary disease patients. All participants underwent clinical evaluation, spirometry and electrocardiography/echocardiography.
RESULTS
Electrocardiography and echocardiography showed Q-wave alterations and segmental contractility in five (10%) patients. The most frequent echocardiographic finding was mild left diastolic dysfunction (88%), independent of chronic obstructive pulmonary disease stage. The proportion of right ventricular overload (p<0.05) and blockage of the anterosuperior division of the left bundle branch were higher in patients with greater obstruction. In an echocardiographic analysis, mild/moderate chronic obstructive pulmonary disease patients showed more abnormalities in segmental contractility (p<0.05), whereas severe/very severe chronic obstructive pulmonary disease patients showed a higher prevalence of right ventricular overload (p<0.05), increased right cardiac chamber (p<0.05) and higher values of E-wave deceleration time (p<0.05). Age, sex, systemic arterial hypertension, C-reactive protein and disease were included as independent variables in a multiple linear regression; only disease severity was predictive of the E-wave deceleration time [r²=0.26, p=0.01].
CONCLUSION
Chronic obstructive pulmonary disease patients have a high prevalence of left ventricular diastolic dysfunction, which is associated with disease severity. Because of this association, it is important to exclude decompensated heart failure during chronic obstructive pulmonary disease exacerbation.
目的
根据疾病严重程度，慢性阻塞性肺疾病患者的心电图和超声心动图异常的流行情况尚未确定。本研究的目的是评估根据疾病严重程度评估慢性阻塞性肺疾病患者心电图和超声心动图异常的发生率。
方法
该研究纳入了 25 例轻度/中度慢性阻塞性肺疾病患者和 25 例重度/极重度慢性阻塞性肺疾病患者。所有参与者均接受了临床评估、肺功能检查、心电图/超声心动图检查。
结果
心电图和超声心动图显示 5 名（10%）患者存在 Q 波改变和节段性收缩功能障碍。最常见的超声心动图表现为轻度左室舒张功能障碍（88%），与慢性阻塞性肺疾病阶段无关。右心室超负荷的比例（p<0.05）和左束支前上分支阻滞在阻塞程度较高的患者中更高。在超声心动图分析中，轻度/中度慢性阻塞性肺疾病患者节段性收缩功能障碍的异常更为常见（p<0.05），而重度/极重度慢性阻塞性肺疾病患者右心室超负荷的发生率更高（p<0.05）、右心腔增大（p<0.05）和 E 波减速时间增加（p<0.05）。年龄、性别、高血压、C 反应蛋白和疾病被纳入多元线性回归的独立变量；只有疾病严重程度与 E 波减速时间具有相关性[r²=0.26，p=0.01]。
结论
慢性阻塞性肺疾病患者左心室舒张功能障碍的发生率较高，且与疾病严重程度相关。由于这种相关性，在慢性阻塞性肺疾病恶化期间排除失代偿性心力衰竭非常重要。
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