Prevalence, Persistence and Outcomes of Left Ventricular (LV) and Right Ventricular (RV) Dysfunction in Patients Admitted with Exacerbation of Chronic Obstruction Pulmonary Disease (ECOPD)

IntroductionLV and RV dysfunction are common in patients with ECOPD, yet little is known about rates of resolution and associations with post-exacerbation outcomes.MethodsEchocardiography was performed on patients hospitalised with ECOPD, and repeated at stability after 90 days. LV and RV function were measured, with data reviewed by a second, blinded clinician. 365-day outcomes were recorded, including days alive outside hospital (DAOH365).Results55 patients were assessed. 3 died and 9 withdrew before 90 days; 43 had follow-up echocardiography. The tables show rates of (new) diagnosis, resolution and outcomes, according to different diagnostic classifications. Ventricular dysfunction was a new finding in a substantial majority of cases. Severe LV dysfunction was significantly associated with increased mortality; there was a trend towards fewer DAOH365 with worse LV function. In most patients, echocardiographic abnormalities resolved at 90 days. Right ventricular dysfunction during ECOPD was not associated with worse 1-year outcomes.DiscussionEchocardiography at the time of ECOPD is worthwhile: ventricular dysfunction is highly prevalent and usually unknown. Severe LV dysfunction portended a dichotomous outcome: early death, or universal resolution in treated survivors. Those with the adverse outcome had markedly worse breathlessness and frailty scores, and many more recent admissions. The absence of a negative prognostic effect for RV dysfunction contrasts with previous echocardiography studies.1[SJ(N1] This is probably because our study was conducted mid-exacerbation: for survivors after 90 days, RV dysfunction was significantly associated with subsequent mortality (50% vs 11%, p=0.048). This suggests clinicians should be cautious about using inpatient echocardiography to diagnose cor pulmonale. The distributions of DAOH365 were heavily left-skewed, limiting straightforward methods to identify population differences. Nevertheless, DAOH365 may be a more expedient outcome measure in this population than time to readmission/death, given the insensitivity of the latter to repeated events, which occurred in over half this cohort.ReferenceBurgess MI, Mogulkoc N, Bright-Thomas RJ, Bishop P, Egan JJ, Ray SG. Comparison of echocardiographic markers of right ventricular function in determining prognosis in chronic pulmonary disease. J Am Soc Echocardiogr. 2002 Jun;15(6):633–9.