ALTERACIONES CARDÍACAS Y VASCULARES PULMONARES EN LA ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA

Abstract

Cardiovascular disease (CVD) is considered the most common comorbidity of chronic obstructive pulmonary disease ( COPD). These two entities share common etiologic factors, mainly smoking, which could partly explain the close relationship between them. However, studies show that cardiovascular events are more common in patients with COPD compared to smokers without the disease._x000D_ The morphological description of the cardiac chambers in COPD through echocardiography, and the estimation of pulmonary artery systolic pressure (PAPs) show the problem of a suboptimal quality when the hyperinsufflation and diaphragmatic flattening are coexistent. This has generated several methodological limitations of echocardiographic studies in COPD._x000D_ Pulmonary hypertension (PH) is the most common cardiovascular complication in COPD. Its presence worsens prognosis in these patients. The prevalence of PH in COPD is not established, nor its influence on exercise tolerance. This is mainly because the diagnosis by means of right cardiac catheterization is not indicated for the management algorithm for these patients. The studies available in the literature are from a series of COPD patients which are candidates for lung transplantation or lung volume reduction surgery in which it is assumed that the frequency of HP is increased. Therefore, this prevalence cannot be extrapolated to the entire spectrum of the severity of the disease._x000D_ The overall aim of the thesis was to evaluate the prevalence of cardiac and pulmonary hemodynamics in patients with COPD alterations. In the first study, the prevalence and characteristics of the heart abnormalities (right and left) were analyzed by echocardiography using patients with COPD at their first exacerbation requiring hospital admission. This study was done within the multicenter study "Phenotypic characterization and evolution of COPD” (PAC-COPD). Due to the fact that alterations RV and PH were the most frequent alterations observed, we proposed to determine the prevalence of PH according to the current spirometric classification of the GOLD statement (Global Obstructive Lung Disease). We measured the pulmonary hemodynamic study. This also allowed to analyse the hemodynamic variables at rest and during exercise in a subgroup of patients._x000D_ The results of the first study showed a high prevalence of both morphological and functional alterations of right (48%) and left (27%) heart not related to the severity of the disease. These changes persisted after adjusting for high cardiovascular risk factors, suggesting an independent effect of COPD on cardiovascular risk. In the second study, the prevalence of PH was 18%; lower in grade 2 (7%) and similar in grades 3 and 4 (25% and 22% respectively). However, a significant increase in mean PAP at exercise by 71% of patients even in the GOLD 2 grade was observed, indicating that pulmonary circulation disorders in COPD are initiated at an early stage in the natural history of this disease. The cardiac index was significantly lower in patients who had PH. In conclusion, we can establish that patients with COPD have a high prevalence of cardiac abnormalities in both left and right heart and also that the presence of PH was frequent in patients with expiratory volume in one second (FEV1) less than 50%. The PH could be a factor to be added to the ventilatory limitation which determine exercise capacity in COPD.

Date of Award	17 Dec 2015
Original language	Spanish
Supervisor	Joan Albert Barberá Mir (Director)