A comparative study of pre and post treatment echocardiographic findings in acute exacerbation of COPD patients

Abstract

Background: COPD is currently the 4^th leading cause of death in the world and is projected to increase in coming years and presents as serious global health problem all over the world with a rapid downhill course. It has a significant effects on cardiac functions, most important of which is development of PAH ultimately leading to Cor pulmonale which increases mortality and hospital readmissions for AECOPD (acute exacerbation of COPD). Echocardiography is simple non-invasive method to evaluate the cardiovascular functions in COPD patients.

Objective: To study and compare the results of echocardiographic findings before and after treatment of acute exacerbation of COPD.

Study design: Prospective Observational Hospital based Study.

Materials and Methods: Patients aged > 40 years, both males and females, admitted in SKIMS with AECOPD were subjected to cardiac evaluation with echocardiography to assess pulmonary artery pressures and other cardiac parameters. Patients were categorised as mild, moderate and severe PAH categories. These patients were followed 6 weeks after discharge with repeat echocardiography to reassess any change in cardiac status and pulmonary artery pressures. The recorded data was compiled and entered in spreadsheet and then subjected to statistical analysis using SPSS 20 software. Pre and post treatment comparison of variables was done using paired t test and McNemar chi-square test. A p value of <0.05 was considered statistically significant.

Results: A total of 118 patients (46.6% males and 53.4% females) were recruited in the study of which 111 patients were followed up for repeat echocardiography and 7 patients expired during study. Most of our patients belonged to either group C or D and GOLD stage 3 or 4. During AE, 20.7% patients had mild PAH, 45.9% had moderate PAH and 33.3% had severe PAH and on follow up 64% of patients had mild PAH, 31.55% had moderate PAH and only 4.5% had severe PAH with an overall reduction in mean RVSP on follow up, signifying increase in PAH during AECOPD. We also found a direct correlation between severity of PAH and pCO2. There was also a significant correlation between severity of airflow limitation and severity of PAH. Analysis of mortality parameters revealed mortality to be directly related to severity of PAH, risk of exacerbation, degree of airflow limitation and presence of LVDD.

Conclusion: COPD is one of the leading cause of morbidity and mortality worldwide. Cardiovascular diseases is recognised as one of the important predictor of in hospital and long term mortality following AECOPD. COPD exacerbations have a negative impact on RV function and Pulmonary artery pressures. Echocardiography is a simple tool for evaluation of cardiac functions in patients with COPD during acute exacerbation as well on follow up to know their actual PAP and thus help in identifying individuals likely to suffer increased mortality and morbidity warranting close monitoring and intense treatment.

Keywords: COPD, Echocardiography, PAH (pulmonary artery pressure)

Correspondence to: Dr Tahir Ashraf Kar (PG1653), Department of Internal Medicine SKIMS.

                                Contact no: 7006462983/ 9906968120    Email: kartahir39@gmail.com