Prevalence of Left Ventricular Systolic Dysfunction in Chronic Obstructive Pulmonary Disease

BACKGROUND : COPD is now more prevalent in both developed and developing countries. It is projected to be the third most common cause of death and fifth most common cause of chronic disability by the year 2030. In India half a million people die of COPD.COPD obscure the clinical signs of coexisting left ventricular dysfunction like cough, dyspnea, paroxysmal nocturnal dyspnea and orthopnea. Symptoms of dyspnea in COPD can be partially due to LV systolic and diastolic dysfunction. More number of patients is either under or wrongly diagnosed, that leads to worsening and development of complications. Early identification and treatment of LV dysfunction can improve the patient’s symptoms. AIM OF THE STUDY : To study the prevalence of LV systolic dysfunction in COPD patients and to assess the possible risk factors contributing to the development of LV systolic dysfunction. METHODS AND MATERIALS : The study design was approved by the Ethical Committee of the institution. This study was done at Government Royapettah Hospital, Chennai between May 2013 to October 2013. This is a cross sectional study in which 50 patients with COPD more than 40 years of age. Severity of COPD is assessed by Spirometry. LVEF was measured by 2D Echo. Duration of smoking and smoking index also was calculated. RESULTS : Among the 50 COPD patients, duration of smoking, smoking index and severity of COPD correlated with LVEF. ‘p’ value was significant. COPD is more prevalent in males. Most patients belong to low socio economic status. COPD severity is directly proportional to smoking index and duration of smoking. Our study reports that 10% of the COPD patients have LV systolic dysfunction. A higher smoking index and prolonged duration of smoking is associated with poor LV systolic function. Increasing severity of COPD is associated with worsening of LV systolic function. CONCLUSION : LV systolic dysfunction is directly proportional to severity of COPD. Smoking index and duration of smoking are positively correlated with development of LVSD. Routine echocardiography is recommended for all severe COPD patients. Smoking cessation should be a vital part of treatment plan in COPD patients. In COPD patients with LVSD, it may be good to introduce selective beta-1 blocker, diuretics, ACE inhibitors, angiotensin-II antagonist and aldosterone antagonist