ECHOCARDIOGRAPHIC FINDINGS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS Affiliation

Introduc on Chronic Obstruc ve Pulmonary Disease (COPD) is parenchymal lung disease with systemic effects and hemodynamic altera on more so in pulmonary circula on. In COPD, right ventricular (RV) a er load increases due to structural and mechanical changes in the pulmonary vascular bed leading to increase in pulmonary arterial pressure which also leads to altera on in structure and func on of RV. In COPD, conges ve cardiac failure and ventricular dysfunc on may coexist and demands proper assessment and management of dual condi on. Objec ves This study was aimed to study the effect of COPD in cardiac anatomical and func onal parameters in COPD pa ents in Shree Birendra Hospital. Methodology This study was a retrospec ve review of hospital data on echocardiographic findings in 86 COPD pa ents visi ng the outpa ent department (OPD) in six months from June 2016 to December 2016. Available data was entered, edited and analyzed using Sta s cal package for social sciences (SPSS) version 22. Results Among 86 cases studied, 43% had dilated RA and 41% with dilated RV, 24% with dilated LA and dilated LV in 22%. Normal pulmonary artery pressure was present in 41 (48%) cases and 45(52 %) individuals were having PAH. Among valvular disorder tricuspid regurgita on was commonest (50%). Le ventricle abnormali es like dilated le ventricles, LVDD, concentric ventricular hypertrophy, LVSD were also presented in significant number of COPD pa ents coun ng 22%, 37%, 7%, 30% respec vely. Among the various factors analyzed in echocardiogram; there was significant associa on between the PAH with right atrial dilata on, right ventricular dilata on, le atrial dilata on, LVDD, tricuspid regurgita on (p<0.05) while rest of the parameters were not sta s cally significant associa on. Conclusion COPD in most instances associated with some form of cardiac abnormali es like PAH, LVDD, LVSD, TR, dilated cardiac chambers so echocardiographic evalua on in mely basis has pivotal role in COPD cases to detect hemodynamic and mechanical altera ons.


Methodology
This study was a retrospec ve review of hospital data on echocardiographic findings in 86 COPD pa ents visi ng the outpa ent department (OPD) in six months from June 2016 to December 2016.Available data was entered, edited and analyzed using Sta s cal package for social sciences (SPSS) version 22.

Results
Among 86 cases studied, 43% had dilated RA and 41% with dilated RV, 24% with dilated LA and dilated LV in 22%.Normal pulmonary artery pressure was present in 41 (48%) cases and 45(52 %) individuals were having PAH.Among valvular disorder tricuspid regurgita on was commonest (50%).Le ventricle abnormali es like dilated le ventricles, LVDD, concentric ventricular hypertrophy, LVSD were also presented in significant number of COPD pa ents coun ng 22%, 37%, 7%, 30% respec vely.Among the various factors analyzed in echocardiogram; there was significant associa on between the PAH with right atrial dilata on, right ventricular dilata on, le atrial dilata on, LVDD, tricuspid regurgita on (p<0.05) while rest of the parameters were not sta s cally significant associa on.

INTRODUCTION
Chronic Obstruc ve Pulmonary Disease (COPD) is parenchymal lung disease with profound systemic effects like chronic hypoxemia leading to pulmonary arterial hypertension.COPD alters hemodynamics leading to cardiac parametric altera on and if severe even right heart 1 failure.So, it is a commonly encountered diagnosis in medicine having high disease morbidity and mortality.COPD is associated with structural and mechanical changes in the pulmonary vascular bed that increase Right Ventricular (RV) a er load.Impaired RV systolic func on, hypertrophy and dilata on present even at slight increase of mean pulmonary arterial pressure, which indicates early 2 impact on RV func on and structure in pa ents with COPD.Transthoracic echocardiography is a useful tool to detect various cardiac abnormali es demanding special [3][4][5] treatment which may need special care.Chronic Heart failure (CHF) and COPD frequently coexist, and ventricular 5 dysfunc on has poor outcome.These days this inves ga on modality is available in most part of the world 6 and even in Nepal.Reversible cardiac ischemic defects are common in advanced COPD pa ents with le ventricular diastolic dysfunc on (LVDD) without the presence of common risk factors but has to be detected and well 7 managed to prevent dire consequences.
Present study was done to study the effect of COPD in cardiac anatomical & func onal parameters and observe the le ventricular systolic dysfunc on (LVSD) associated with cases of COPD among veterans and their families in a ter ary center at Kathmandu

METHODOLOGY
This study was retrospec ve review of, hospital data on echocardiographic findings in 86 COPD pa ents visi ng the OPD in six months from June 2016 to December 2016 in Shree Birendra Army Hospital (SBH), Chhauni.SBH is the only ter ary level hospital for Nepalese serving soldier, veterans and their family.The diagnosis of COPD was made based on the history, signs and symptoms and in selec ve cases radiological inves ga ons like chest X-ray, spirometry, electrocardiography and echocardiography.Among the pa ent with some an cipated cardiovascular remodeling due to COPD is usually advised for the echocardiographic assessment in our ins tu on.The properly managed data in record keeping book in six months were addressed for this study a er ethical approval from ins tu onal review commi ee.
Echocardiographic examina on was done to see cardiac structural and func onal abnormali es due to remodeling associated with underlying COPD.Pa ents having other respiratory and cardiovascular comorbidi es like bronchial asthma, tuberculosis, hypertension, valvular heart diseases were excluded.Those echocardiographic findings were recorded manually in the record book of Echo-room.Available data was retrieved, entered, and analyzed using Sta s cal package for social sciences (SPSS) version 22. Chi-square test was used to see the associa on between variables studied.

Ventricular func onal parameter Yes No
Le ventricular diastolic dysfunc on 32(37%) 54(63%) There was le ventricular diastolic dysfunc on found among 37% of the individuals with COPD and in 30% there was le ventricular systolic dysfunc on (LVSD) (ejec on frac on (EF) ≤55%) (Table 4.).Among those having LVSD; Among the various factors analyzed in echocardiographic assessment; there was significant associa on between the PAH with right atrial dilata on, right ventricular dilata on, le atrial dilata on, LVDD, Tricuspid regurgita on (p<0.05) while rest of the parameters did not have.

DISCUSSION
COPD is a chronic lung parenchymal disease of elderly group usually a er 40 years which was found true with our study with mean age of pa ents being 69.85±10.36years and this

CONCLUSION
COPD is in most instances associated with some form of cardiac abnormali es so echocardiographic evalua on in mely basis has pivotal role in early detec on of the hemodynamic and mechanical altera ons like PAH, LVDD, LVSD, TR, dilated cardiac chambers etc.

RECOMMENDATIONS
Further is needed.Large mul -centered follow up studies in Nepalese se ng.Though it is known that cardiac abnormali es may be associated with COPD pa ents based on some ins tu onal observa on; they have to be properly followed up and mely interven on of the condi on is a must.

Table 1 :
Status of the heart chamber among the COPD pa ents

Table 2 :
Distribu on of pa ents by Pulmonary Arterial Hypertension

Table 5 :
Various cardiac parameters and its comparison with PAH Shrestha DB et al and community it varies and one study showed TR in 77% of 8 the COPD pa ents.Le ventricle abnormali es like dilated le ventricles, LVDD, concentric ventricular hypertrophy, LVSD are also present in significant number of COPD pa ents in our study accoun ng 22%, 37%, 7%, 30% respec vely while in another study, le ventricle 4 enlargement was seen in 6%, LVDD in 12%, LVSD in 13%.
1 is also supported by other studies as well.Pulmonary arterial hypertension is the common finding with those individuals with COPD and this study revealed 45(52%) individuals having PAH which is comparable with another 8 study where PAH was 55% among COPD cases.In contrast one small study including 50 COPD pa ents showed PAH in 70% and while two other shared quite low 38.7%, 19%PAH 5 evalua on readily and reliably detects the PAH.The Copenhagen City Heart Study showed LVH prevalence significantly high in COPD (17.7%) than without COPD (12.1%).Same study also stresses, pa ents having COPD will 11 have high cardiovascular diseases.Among valvular disorder associated with COPD, tricuspid regurgita on was commonest one (50%) with different severity in our study and depending on the study sample Birat Journal of Health Sciences Vol.3/No.1/Issue5/ Jan-April 2018