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

Twenty-nine patients with cor pulmonale were investigated by echocardiography and cardiac catheterisation in order to assess the significance of a reduced mitral E-F slope. Seven patients had coronary arterial disease and were therefore excluded from further analysis. Of the remaining 22 patients, 15 had a reduced mitral E-F slope but an otherwise normal mitral valve on echocardiography. They were found to have an increased left ventricular end-diastolic pressure measured at cardiac catheterisation when compared to the other seven patients with cor pulmonale and a normal E-F slope. The patients with a reduced E-F slope had an increased mean right ventricular internal dimension and interventricular septal thickness measured echocardiographically when compared to the patients with a normal E-F slope. Right ventricular dysfunction was suggested in these patients by an increased right ventricular end-diastolic pressure measured at cardiac catheterisation. We discuss possible mechanisms of left ventricular dysfunction and of intracardiac pressure transmission in cor pulmonale, and the implications of these mechanisms for effective management.