Echocardiographic Changes in Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review of Pre- and Post-treatment Findings.

Chronic obstructive pulmonary disease (COPD) exacerbations can precipitate acute cardiac dysfunction, but the extent and reversibility of these changes remain incompletely defined. This Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)‑compliant systematic review synthesised evidence from 11 prospective or observational cohort studies (2015-2025) that met predefined inclusion/exclusion criteria, enrolling ≥10 adults with acute exacerbations of COPD (AECOPD) diagnosed per Global Initiative for Chronic Obstructive Lung Disease (GOLD) or equivalent criteria, and undergoing transthoracic echocardiography pre‑treatment and post‑stabilisation. Echocardiographic parameters assessed included pulmonary artery systolic pressure (PASP), right ventricular (RV) size and systolic function, tricuspid regurgitation, and diastolic indices. Methodological quality, evaluated using the Newcastle-Ottawa Scale (NOS), was moderate (scores 5-8; Cohen's κ = 0.87). In exacerbations, PASP was frequently >50 mmHg, RV dilated, and tricuspid annular plane systolic excursion (TAPSE) reduced, indicating acute RV pressure overload. Post‑treatment, PASP reductions averaged 10-15 mmHg, and greater improvements correlated with shorter intensive care unit stays and reduced 30‑day readmissions; TAPSE recovery was also linked to earlier discharge. Subclinical diastolic dysfunction and functional tricuspid regurgitation were variably reversible, with persistent moderate-severe tricuspid regurgitation in 12-18% linked to structural annular dilation. Heterogeneity in protocols precluded meta‑analysis, prompting narrative synthesis and subgroup analyses by GOLD stage; publication bias was considered but not formally assessed because no outcome was reported by ≥10 studies. Findings highlight echocardiography's prognostic value in AECOPD and support the need for standardised imaging protocols, integration with biomarker profiling, and longitudinal studies to clarify the long‑term significance of persistent abnormalities.