Left atrial and ventricular filling in chronic obstructive pulmonary disease - An echocardiographic and Doppler study

Abnormal left ventricular (LV) diastolic function has frequently been repor ted in patients with chronic obstructive pulmonary disease (COPD). In the p resent work, diastolic function was studied by a combined analysis of pulmo nary venous and mitral blood flow velocities in 34 patients with COPD clini cally stable and without history of heart disease, and 20 control subjects. We confirmed the increased contribution of the atrial contraction to the L V filling in COPD patients in comparison with control subjects; furthermore , a decreased left atrial (LA) filling during the ventricular systole was o bserved. Changes in LV filling were not the consequence of a systolic dysfu nction, because LV systolic function was normal. Doppler indices indicated that LA pressure was below 15 cm H2O in all the patients with COPD and cont rol subjects. Several factors can be put forward to explain these changes; the first one is tachycardia. In addition to hypoxemia and medications, ech ocardiography suggested that a decreased LV preload participated in increas ed heart rate. Analysis of Doppler transmitral and pulmonary venous flows d emonstrated the role of the ventricular interdependence because a correlati on existed between LA and LV filling pattern and right ventricle pressure a nd diameter.