Echocardiographic characteristics of cardiac performance in patients with exacerbation of chronic obstructive pulmonary disease in the dynamics of the disease

Introduction. Chronic obstructive pulmonary disease (COPD) and chronic heart failure are often combined in clinical practice and present difficulties in differential diagnosis. COPD exacerbations can lead to deterioration of cardiac function, significantly affecting the prognosis of the disease.

We aimed to estimate diagnostic significance of cardiac activity indices obtained by echocardiography in COPD exacerbation and in the dynamics of the disease.

Materials and methods. The study included 128 people, including 103 patients with COPD exacerbation, who made up 3 groups: group A (n = 21), group B (n = 24), group E (n = 58) in according to GOLD (2023) categorization. The control group consisted of 25 people without COPD. In the course of the study, the following control points were established: 1st follow-up point – primary examination, 2nd point – after 3-6 months, 3rd point – after 9-12 months. The diagnosis of COPD and the degree of FEV₁ limitation were confirmed by the results of spirometry on Easy on-PC (ndd Medizintechnik AG, Switzerland) before and after the bronchodilator test. Lung function was additionally assessed by diffusiometry. CAT and mMRC questionnaires were used for clinical characterization of patients. Structural and functional state of the heart was assessed by transthoracic echocardiography with 5 MS sector transducer with the frequency of 1.5-4.6 mHz using constant-wave, pulsed-wave Doppler modes, tissue Doppler and speckle-tracking echocardiography to assess global longitudinal ventricular strain.

Results. In all groups of COPD patients at exacerbation the changes of cardiac activity were revealed, as evidenced by the decrease of systolic function indices of both heart ventricles and signs of diastolic dysfunction, the most pronounced in group E in patients with high risk of exacerbations and pronounced clinical manifestations of the disease. According to the correlation analysis, systolic and diastolic dysfunction of both heart ventricles are associated with the degree of airway patency disorders, lung diffusion capacity and associated with an increase in NT-proBNP. In patients of groups A and B partial correction of some echocardiographic parameters in 3-6 months after exacerbation was noted. In group E, unfavorable tendencies to deterioration of cardiac activity are formed within a year.

Conclusion. COPD exacerbation is accompanied by changes in echocardiographic parameters reflecting structural and functional heart disorders and precapillary pulmonary hypertension, most pronounced in group E. Echocardiographic monitoring provides a complete analysis of the dynamics of changes in cardiac performance in COPD patients who have undergone exacerbation of the disease, which is of great clinical importance for prognosis and development of treatment tactics.

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