Kronik Obstrüktif Akciğer Hastalığında Solunum Fonksiyonlarının ve Pulmoner Arter Basıncının Sağ ve Sol Ventrikül Diyastolik Fonksiyonları Üzerine Etkisi

Abstract

Giriş: Bu çalışmada, kronik obstrüktif akciğer hastalığı (KOAH) olan kişilerde konvansiyonel ve doku Doppler ekokardiyografi yle sağ ve sol ventrikül diyastolik fonksiyonlarını değerlendirmeyi, solunum fonksiyonları ve pulmoner arter basıncının diyastolik fonksiyonlar üzerine etkisini araştırmayı amaçladık. Hastalar ve Yöntem: KOAH'lı 60 hasta ve 40 sağlıklı birey iki boyutlu, M-mode, konvansiyonel ve doku Doppler ekokardiyografi yle değerlendirildi. Tüm bireylere solunum fonksiyon testleri (SFT) ile birinci saniyedeki zorlu ekspiratuvar volüm [forced expiratory volume in 1 second (FEV1)] ve zorlu vital kapasite [forced vital capacity (FVC)] tayini yapıldı. FEV1, FEV1/FVC ve ortalama pulmoner arter basıncı (OPAB) ile diyastolik fonksiyon parametreleri arasındaki ilişkiyi araştırmak için korelasyon ve regresyon analizi yapıldı. Bulgular: KOAH grubunda sağ ventrikül çapı ve serbest duvar kalınlığı daha fazla, triküspit E ve E/A, triküspit lateral annulus E' ve E'/A', mitral annulus septal E' ve E'/A' değerleri daha düşük, mitral E/mitral annulus septal E' değeri daha yüksekti (p değerleri < 0.05). FEV1 ile triküspithastalılateral annulus E' ve E'/A' arasında pozitif korelasyon vardı. Triküspit E/A, triküspit lateral annulus E' ve E'/A', mitral annulus septal E' ve E'/A' değerleriyle FEV1/FVC arasında pozitif, OPAB arasında negatif korelasyon vardı. Mitral E/mitral annulus septal E'değeriyle FEV1/ FVC arasında negatif, OPAB ile pozitif korelasyon vardı. FEV1/FVC, triküspit lateral annulus E' ve E'/A', mitral annulus septal E' ve E'/A' için belirleyiciydi. Sonuç: KOAH hastalarında sağ ve sol ventrikül diyastolik fonksiyonları bozulmaktadır. Bu hastalarda, kronik hipoksi ve pulmoner basınç artışı sağ ve sol ventrikül diyastolik fonksiyon bozukluğu gelişmesinde etkili faktörlerdir.

Keywords

• Pulmoner hastalık, kronik obstrüktif, ekokardiyografi, solunum fonksiyon testleri, kalp yetersizliği; diyastolik.

The Effect of Respiratory Functions and Pulmonary Artery Pressure on Right and Left Ventricular Diastolic Function

Abstract

Introduction: The aim of the study was to evaluate of biventricular diastolic function and to investigate the effect of pulmonary function and pulmonary artery pressure on diastolic functions in people with chronic obstructive pulmonary disease (COPD). Patients and Methods: Sixty patients with COPD and 40 healthy individuals were assessed by echocardiography and pulmonary function tests (PFTs). Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were determined. Correlation and regression analysis were performed to investigate the relationship between FEV1, FEV1/FVC, mean pulmonary artery pressure (MPAB) and diastolic function parameters. Results: Right ventricular diameter and free wall thickness and mitral E/mitral septal annulus E' were higher whereas tricuspid E and E/A, tricuspid lateral annulus E' and E'/A', mitral septal annulus E' and E'/A' values were lower in the COPD group (all p values of < 0.05). FEV1 was positively correlated with lateral tricuspid annulus E' and E'/A'. Tricuspid E/A, tricuspid lateral annulus E' and E'/A', mitral septal annulus E' and E'/A' values were positively correlated with FEV1/FVC, whereas negatively correlated with MPAB. Mitral E/mitral annulus septal E' was negatively correlated with FEV1/FVC, and positively correlated with MPAB. FEV1/FVC was decisive for tricuspid lateral annulus E' and E'/A', mitral annulus septal E' and E'/A' values. Conclusion: Right and left ventricular diastolic function are impaired in patients with COPD. Chronic hypoxia and increased pulmonary pressure are important factors in the development of diastolic dysfunction in patients with COPD.

Keywords

• Pulmonary disease, chronic obstructive, echocardiography, respiratory function tests, heart failure; diastolic.

References

1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532- 55.
2. Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmo- nary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis 2009;4:37-49.
3. Gürgün A, Gürgün C. Kronik obstrüktif akciğer hastalığı ve kardiyovasküler sistem Tuberk Toraks 2008;56:64-71.
4. Naeije R. Pulmonary hypertension and right heart failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2005;2:20-2.
5. Weitzenblum E. Chronic cor pulmonale. Heart 2003;89:225- 30.
6. Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E Jr, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Can- ada cardiovascular disease in COPD patients. Ann Epidemiol 2006;16:63-70.
7. Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009;11:130-9.
8. Ho CY, Solomon SD. A clinician’s guide to tissue Doppler im- aging.Circulation 2006;113:396-8.

9. Wheeldon NM, MacDonald TM, Flucker CJ, McKendrick AD, McDevitt DG, Struthers AD. Echocardiography in chronic heart failure in the community. Q J Med 1993;86:17-23.
10. Rutten FH, Moons KG, Cramer MJ, Grobbee DE, Zuithoff NP, Lammers JW, et al. Recognising heart failure in elderly patients with stable chronic obstructive pulmonary dis- ease in primary care: cross sectional diagnostic study. BMJ 2005;10;331(7529):1379.
11. Sabit R, Bolton CE, Fraser AG, Edwards JM, Edwards PH, Ionescu AA, et al. Sub-clinical left and right ventricular dys- function in patients with COPD. Respir Med 2010;04:1171-8.
12. Karabulut A, İltümür K, Durak D, Toprak N. Sağ ventrikül di- yastolik fonksiyonlarının kronik obstrüktif akciğer hastalığının evrelerine göre değerlendirilmesi. Dicle Tıp Dergisi 2005;32:145-8.
13. Miyahara Y, Ikeda S, Yoshinaga T, Yamaguchi K, Nishimura- Shirono E, Yamasa T, et al. Echocardiographic evaluation of right cardiac function in patients with chronic pulmonary dis- eases. Jpn Heart J 2001;42:483-93.
14. Boussuges A, Pinet C, Molenat F, Burnet H, Ambrosi P, Badier M, et al. Left atrial and ventricular fi lling in chronic obstructive pulm onary disease. An echocardiographic and Doppler study. Am J Respir Crit Care Med 2000;162:670-5.
15. Funk GC, Lang I, Schenk P, Valipour A, Hartl S, Burghuber OC. Left ventricular diastolic dysfunction in patients with COPD in the presence and absence of elevated pulmonary arterial pressure. Chest 2008;133:1354-9.
16. Ozer N, Tokgözoglu L, Cöplü L, Kes S. Echocardiographic evaluation of left and right ventricular diastolic function in pa- tients with chronic obstructive pulmonary disease.J Am Soc Echocardiogr 2001;14:557-61.
17. Suchoń E, Tracz W, Podolec P, Pieculewicz M, Płazak W, Prokop A, et al. Evaluation of left ventricular function in pa- tients with chronic obstructive pulmonary disease. Pol Arch Med Wewn 2007;117:26-30.
18. Acikel M, Kose N, Aribas A, Kaynar H, Sevimli S, Gurlertop Y, et al. Erol MK. The effect of pulmonary hypertension on left ventricular diastolic function in chronic obstructive lung dis- ease: a tissue Doppler imaging and right cardiac catheteriza- tion study. Clin Cardiol 2010;33:13-8.
19. Standardization of Spirometry, 1994 Update. American Tho- racic Society. Am J Respir Crit Care Med 1995;152:1107-36.
20. Masuyama T, Kodama K, Kitabatake A, Sato H, Nanto S, Inoue M. Continuous-wave Doppler echocardiographic de- tection of pulmonary regurgitation and its application to non- invasive estimation of pulmonary artery pressure. Circulation 1986;74:484-92.
21. Fisher MR, Forfi a PR, Chamera E, Housten-Harris T, Cham- pion HC, Girgis RE, et al. Accuracy of Doppler echocardiogra- phy in the hemodynamic assessment of pulmonary hyperten- sion. Am J Resp Crit Care Med 2009;179:615-21.
22. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Task Force for Diagnosis and Treatment of Pulmonary Hypertension of European Society of Cardiology (ESC); European Respiratory Society (ERS); International So- ciety of Heart and Lung Transplantation (ISHLT). Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 2009; 34:1219-63.
23. Vizza CD, Lynch JP, Ochoa LL, Richardson G, Trulock EP. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest 1998;113:576-83.
24. Jessup M, Sutton SG, Weber K, Janicki JS. The effect of chronic pulmonary hypertension on the left ventricular size, function, and interventricular septal motion. Am Heart J 1987;113:1114-22.
25. Schena M, Clini E, Errera D, Quadri A. Echo-Doppler evalu- ation of left ventricular impairment in chronic cor pulmonale. Chest 1996;109:1446-51.
26. Sietsema K. Cardiovascular limitations in chronic pulmonary disease. Med Sci Sports Exerc 2001;33:656-61.
27. MacNee W. Pathophysiology of cor pulmonale in chronic ob- structive pulmonary disease. Am J Respir Crit Care Med 1994;150:833-52.
28. Matthay AR, Niederman MS, Wiedemann HP. Cardiovascular- pulmonary interaction in chronic obstructive pulmonary dis- ease with special reference to the pathogenesis and manage- ment of cor pulmonale. Med Clin North Am 1990;74:571-615.