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      Right Ventricular Diastolic Function and Exercise Capacity in COPD

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          Abstract

          Background

          Decreased exercise capacity in chronic obstructive pulmonary disease (COPD) is incompletely explained by pulmonary pathologic and physiologic abnormalities. We evaluated the extent to which right ventricular diastolic function (RVDF) is associated with exercise capacity in COPD.

          Methods

          Fifty-one patients with COPD were evaluated by echocardiography, spirometry, and the 6 minute walk test (6MWT). RVDF was assessed using 4 echocardiographic parameters: 1) the ratio of tricuspid valve (TV) early (E) and late (A) inflow velocities (TV E/A) 2) TV early tissue Doppler velocity (TV e’) 3) TV deceleration time (DT) and 4) the ratio of TV E and e’ velocities (TV E/e’). Multiple linear regression was used to examine the extent to which these parameters were associated with 6MWT distance. All models adjusted for age, sex, post-bronchodilator FEV 1/FVC, resting heart rate, and use of supplemental O 2 during 6MWT. A regression model was calculated for each of the 4 markers of RVDF.

          Results

          Forty-seven percent of the sample had GOLD stage III or IV COPD. All 51 subjects had preserved left ventricular ejection fraction (LVEF, mean = 71.7%, SD = 7.8%). A higher TV E/A ratio was associated with increased 6MWT distance (p = 0.001). TV e’, TV DT and TV E/e’ did not have a statistically significant association with 6MWT distance in regression models.

          Conclusions

          In a cohort with moderate to severe COPD and normal LVEF, TV E/A was associated with 6MWT distance after adjusting for relevant demographic and medical covariates. RV diastolic dysfunction may independently contribute to exercise intolerance in COPD.

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          Author and article information

          Journal
          8908438
          7035
          Respir Med
          Respir Med
          Respiratory medicine
          0954-6111
          1532-3064
          3 February 2016
          09 September 2015
          October 2015
          01 October 2016
          : 109
          : 10
          : 1287-1292
          Affiliations
          [1 ]National Jewish Health, Division of Cardiology, Denver, CO, United States
          [2 ]National Jewish Health, Division of Pulmonary, Critical Care, and Sleep Medicine, Denver, CO, United States
          [3 ]University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Medicine, Aurora, CO, United States
          [4 ]Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, United States
          [5 ]University of Colorado School of Medicine at the Anschutz Medical Campus, Department of Psychiatry, Aurora, CO, United States
          [6 ]University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States
          Author notes
          Corresponding Author Address: fensterb@ 123456njhealth.org
          Article
          PMC4745988 PMC4745988 4745988 nihpa755677
          10.1016/j.rmed.2015.09.003
          4745988
          26371994
          0b2f2ace-a30f-4a5e-bf5f-d4f22b20291a
          History
          Categories
          Article

          COPD,right ventricle,exercise,diastolic function
          COPD, right ventricle, exercise, diastolic function

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