Evaluation of Speckle-Tracking Echocardiography in COPD Patients Without Comorbidities

Chronic obstructive pulmonary disease (COPD) and heart failure represent 2 entities of a growing global burden that share common clinical and etiological characteristics. Timely identification of heart failure is imperative for effective management. This study aimed to investigate subclinical left ventricular (LV) dysfunction by conventional and speckle-tracking echocardiography (STE) methods in COPD patients. 

This is a prospective cohort study on 46 (54.1%) newly diagnosed patients with COPD without comorbidities (formerly diagnosed with confounders for evaluating cardiac performance: arrhythmias, diabetes, old age, hypertension, renal failure, and cardiovascular or valvular disease) (46.80±4.67 y, 30 (65.2%) males), and 39 (45.9%) age- and sex-matched healthy control smokers. COPD patients were classified based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. 

Contrary to conventional echocardiographic parameters, STE revealed impairment of the LV basal circumferential strain (BCS) among COPD patients (-21.20%±3.89% vs -23.70±5.75; P=0.003) and gradually reduced with the severity of COPD GOLD (P=0.007), indicating LV dysfunction. Regarding global circumferential or longitudinal STE, COPD patients did not vary significantly (P=0.10, 0.57). In multiple linear regression analysis, spirometry parameters (FEV1(L), FEV%, FVC(L), FVC%, and FEV1/FVC) predicted BCS (P=0.023).Right bundle branch block was observed more frequently (P=0.005) and the tricuspid annular plane systolic excursion level was significantly lower (P=0.017) among the COPD group. The results were associated with the degree of COPD GOLD severity (P=0.036), indicating right ventricular dysfunction. 

COPD seems to be accompanied by impaired subclinical right ventricular and regional-level LV deformation properties that worsen in stages of COPD GOLD.