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Early Changes of Cardiac Structure and Function in COPD Patients With Mild Hypoxemia^*

^* From the Departments of Pulmonary Medicine (Drs. Vonk-Noordegraaf, Roseboom, Postmus, and Mr. Holverda) and Physics and Medical Technology (Dr. Marcus), Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.

Correspondence to: Anton Vonk-Noordegraaf, MD, PhD, FCCP, Vrije Universiteit Medical Center, Department of Pulmonary Medicine, PO Box 7057, 1007 MB Amsterdam, the Netherlands; e-mail: A.Vonk{at}vumc.nl

Background: COPD is often associated with changes of the structure and the function of the heart. Although functional abnormalities of the right ventricle (RV) have been well described in COPD patients with severe hypoxemia, little is known about these changes in patients with normoxia and mild hypoxemia.

Study objectives: To assess the structural and functional cardiac changes in COPD patients with normal PaO₂ and without signs of RV failure.

Methods: In 25 clinically stable COPD patients (FEV₁, 1.23 ± 0.51 L/s; PaO₂, 82 ± 10 mm Hg [mean ± SD]) and 26 age-matched control subjects, the RV and left ventricular (LV) structure and function were measured by MRI. Pulmonary artery pressure (PAP) was estimated from right pulmonary artery distensibility.

Results: RV mass divided by RV end-diastolic volume as a measure of RV adaptation was 0.72 ± 0.18 g/mL in the COPD group and 0.41 ± 0.09 g/mL in the control group (p < 0.01). LV and RV ejection fractions were 62 ± 14% and 53 ± 12% in the COPD patients, and 68 ± 11% and 53 ± 7% in the control subjects, respectively. PAP estimated from right pulmonary artery distensibility was not elevated in the COPD group.

Conclusion: From these results, we conclude that concentric RV hypertrophy is the earliest sign of RV pressure overload in patients with COPD. This structural adaptation of the heart does not alter RV and LV systolic function.

Key Words: COPD • cor pulmonale • hypoxemia • left ventricle • MRI • pulmonary hypertension • right ventricle • right ventricular hypertrophy • secondary pulmonary hypertension

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