ECHOCARDIOGRAPHIC EVALUATION OF PATIENTS WITH COPD AND ITS CORRELATION WITH THE SEVERITY OF THE DISEASE

1. ECHOCARDIOGRAPHIC EVALUATION OF PATIENTS
WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
AND ITS CORRELATION WITH THE SEVERITY OF THE
DISEASE
• NAME :DR. AMARDIP K. RAJPUT

2. INTRODUCTION
• Chronic Obstructive Pulmonary Disease (COPD) is a major cause of
health care burden worldwide and the only leading cause of death that
is increasing in prevalence. It is the fourth leading cause of death, and
by 2020, is expected to rise to the 3rd position as a cause of death.[1]
• Pulmonary hypertension is a serious complication of COPD and is
associated with poor prognosis. In general pulmonary hypertension is
said to be present when Mean pulmonary artery pressure (MPAP) is
more than 30 mmHg. Pulmonary hypertension associated with COPD is
usually mild to moderate, and in <5% patients it is severe. Pulmonary
artery pressure is known to increase to a great extent during REM
sleep, exercise, acute exacerbations which, eventually leads to right
heart failure. Thus, early detection and treatment of pulmonary
hypertension becomes important to prevent right heart failure.[2]
• This study was undertaken to assess the cardiac changes secondary to
COPD by echocardiography, and to find out the correlation between
echocardiographic findings and the severity of COPD.

3. AIMS AND OBJECTIVES
AIMS:
• Assessment of severity of chronic obstructive
pulmonary disease.
• Echocardiographic assessment of systolic function,
diastolic function and pulmonary artery pressure.
OBJECTIVES:
• To assess the cardiac changes secondary to chronic
obstructive pulmonary disease by echocardiography
and to find out the correlation between
echocardiography findings and the severity of chronic
obstructive pulmonary disease, if there is any.

4. MATERIALS AND METHODS
 Study design
This was a hospital based prospective, observational
case control study.
 Sample size
Total 50 subjects from case and control group each
were included in this study.
 Study duration
November 2013 to June 2015
 METHOD OF COLLECTION OF DATA
Total 50 patients with COPD were selected after
history taking and physical examination supported by
laboratory evidence, ECG, Echo and PFT to assess the
clinical severity and complications.

5.  Inclusion criteria
Adult males and females of age ≥18 years and ≤60
years with history of COPD were selected for the study.
 Exclusion criteria
Patients with primary diagnosis of-
• Bronchial asthma.
• Known sleep apnea.
• Lung cancer.
• Known left ventricular dysfunction.
• Poorly controlled hypertension.
• Valvular heart disease.
• Known coronary artery disease.
• patients with poor echo window.

6. STUDY DETAILS
 Total 50 patients with COPD were selected.
 Confirmed with clinical history and pulmonary function
tests.
 All patients were subjected to routine investigations.
I. complete blood count
II. Lipid profile
III. Blood sugar
IV. Blood urea
V. Serum creatinine
VI. Chest radiography
VII. Electrocardiography

7. STUDY DETAILS
All patients were investigated and by
spirometry and classified according to GOLD
guidelines as follows.
FEV1/FVC ratio <0.7
o Mild: FEV1 >80% predicted.
o Moderate: FEV1 80-50% predicted.
o Severe: FEV1 50-30% predicted.
o Very severe FEV1 <30% predicted.

8. STUDY DETAILS
All patients were subjected to 2-dimentional
transthorasic Doppler echocardiography and
following parameters were assessed.
Tricuspid regurgitant flow.
Right ventricular systolic pressure.
Systolic pulmonary artery pressure.
Right ventricular dimensions.
Ejection fraction.
Right ventricular diastolic dysfunction.
Left ventricular systolic and diastolic function.

9. STUDY DETAILS
Echocardiographic parameters were
correlated with spirometric variables to find
out the correlation of severity of COPD with
echocardiographic findings.

10. RESULTS
COPD grade FEV1 %
Predicted
males M [%] Females F [%] No. of Cases Percentage
Mild ≥80 0 0 0 0% 0 0%
Moderate 50-79 3 37.5 5 62.5 8 16%
Severe 30-49 17 56.67 13 43.33 30 60%
Very severe ≤30 6 50 6 50 12 24%
•Severity of COPD by pulmonary function tests- Of total 50 patients in case group 8
(16%) patients had moderate grade COPD (FEV1 50-79%) [3: M; 5: F]. 30 (60%)
patients had severe grade COPD (FEV1 30-49%) [17: M; 13: F]. 12 (24%) had very
severe grade COPD (FEV1 ≤30%) [6: M; 6: F]
The mean FEV1 was 36.80±9.93 and the mean FEV1/FVC was 57.99±10.23.
Table : Severity of COPD

11. SEVERITY OF COPD BY PULMONARY
FUNCTION TESTS
0
5
10
15
20
25
30
Mild Moderate Severe Very severe
0
8
30
12
No. of Cases

12. Pulmonary
hypertension
COPD severity grading
Grade-2 moderate Grade -3severe Grade-4 very severe Total
Mild 6 14 2 22
Moderate+severe 2 16 10 28
Total 8 30 12 50
•Pulmonary hypertension correlation with COPD - Total 8 (16%) patients in our study
had moderate grade COPD out of which 6 patients had mild pulmonary hypertension
(sPAP 30-50), and 2 patients had moderate to severe pulmonary hypertension (sPAP
50-70, >70). 30 (60%) patients had severe grade COPD out of which 14 patients had
mild pulmonary hypertension (sPAP 30-50) and 16 patients had moderate to severe
pulmonary hypertension (sPAP 50-70, >70). 12 (24%)patients had very severe grade
COPD out of which 2 patients had mild pulmonary hypertension (sPAP 30-50) and 10
patients had moderate to severe pulmonary hypertension (sPAP 50-70, >70).
Pulmonary hypertension was strongly associated with severity of COPD. [chi square
value: 6.8452; DF: 2; ‘p’ value: 0.0326]
Table : Pulmonary hypertension correlation with COPD

13. PULMONARY HYPERTENSION
CORRELATION WITH COPD
0
2
4
6
8
10
12
14
16
Grade-2 moderate Grade -3severe Grade-4 very severe
6
14
22
16
10
Mild
Moderate+severe

14. Diastolic
dysfunction
COPD severity grading
Grade-2 moderate Grade -3 severe Grade-4 very severe Total
Present 8 27 11 46
Absent 0 3 1 4
Total 8 30 12 50
•Diastolic dysfunction correlation with COPD - Total 30 (60%) patients had severe
grade COPD out of which 27 patients had diastolic dysfunction. 12(24%) patients had
very severe grade COPD out of which 11 had diastolic dysfunction. Diastolic
dysfunction was statistically not associated with severity of COPD. [chi square value:
0.806; DF: 2; ‘p’ value :0.650]
Table : Diastolic dysfunction correlation with COPD

15. DIASTOLIC DYSFUNCTION
CORRELATION WITH COPD
0
5
10
15
20
25
30
Grade-2 moderate Grade -3 severe Grade-4 very severe
COPD severity grading
8
27
11
0 3 1
Present
Absent

16. Diastolic dysfunction Present Percent (%) Absent Percent (%) Total
Patients with COPD 46 92 4 30 50
Control cases 15 8 35 70 50
Diastolic dysfunction of case group compared with control group: we compared the
diastolic dysfunction of patients having COPD with control group and found out
that diastolic dysfunction was significantly pravalent in patients with COPD than
control population.
[Chi square value 7.86; DF 1; ‘p’ value 0.005]

17. DIASTOLIC DYSFUNCTION OF CASE
GROUP COMPARED WITH CONTROL
GROUP
0
5
10
15
20
25
30
35
40
45
50
Present Absent
46
4
15
35
Patients with COPD
Control cases

18. Systolic dysfunction COPD severity grading
Grade-2 moderate Grade -3 severe Grade-4 very severe Total
Present 0 6 1 7
Absent 8 24 11 43
Total 8 30 12 50
•Systolic dysfunction and correlation with COPD - Total 30 (60%) patients had severe
grade COPD out of which 6 patients had systolic dysfunction. Total 12 patients had
very severe grade COPD out of which 1 patient had systolic dysfunction. Systolic
dysfunction was statistically not associated with severity of COPD.
[chi square value : 2.519; DF:2; ‘p’ value: 0.283]
Table : Systolic dysfunction correlation with COPD

19. SYSTOLIC DYSFUNCTION AND
CORRELATION WITH COPD
0
5
10
15
20
25
Grade-2 moderate Grade -3 severe Grade-4 very severe
COPD severity grading
0
6
1
8
24
11
Present
Absent

20. CORRELATION OF ECHOCARDIOGRAPHC VALUES WITH
PFT PARAMETERS.
Pearson correlation coefficient
FEV1 FVC FEV1/FVC PEFR
RV 0.038 0.089 0.030 0.005
FS% -0.053 -0.057 -0.019 -0.423
EF% 0.063 -0.020 0.107 -0.320
E 0.088 0.015 0.092 -0.176
A 0.142 0.053 0.135 -0.205
E/A 0.075 0.054 0.001 -0.235
TRvmax 0.105 0.096 0.014 -0.245
TR 0.167 0.138 0.054 -0.277
RVSP -0.19 0.217 -0.51 -0.197
Ea(m) -0.019 -1.98 -0.020 -0.288
Aa(M) 0.020 0.030 -0.031 -0.174
Sa(m) 0.027 -0.093 0.08 -0.132
Ea(l) 0.043 -0.089 0.169 -0.199
Aa(l) 0.069 0.007 0.097 0.174
Sa(l) 0.095 -0.027 0.135 -0.141
Ea/Aa(m
)
-0.017 -0.017 0.017 -0.102
E/Ea(m) 0.195 0.119 0.116 0.139
Ea/Aa(l) 0.015 -0.059 0.081 -0.111
E/Ea(l) -0.103 -0.052 -0.096 -0.177

21. CORRELATION OF FEV1% WITH
ECHOCARDIOGRAPHIC PARAMETERS.
• FEV1 [%] was positively correlated with RV diameter (0.038), ejection fraction [EF]
(0.063), early mitral inflow velocity [E] (0.088), late mitral inflow velocity [A]
(0.142), E/A ratio (0.075).
• FEV1 [%] was positively correlated with TR max jet velocity [TRvmax] (0.105),
tricuspid regurgitant velocity [TR] (0.167), mitral annular velocity during late
diastole [Aa(m)] (0.020), peak systolic mitral annular velocity [Sa(m)] (0.027), early
diastolic velocity of the lateral motion of the mitral annulus [Ea(l)] (0.043), late
diastolic velocity of the lateral motion of the mitral annulus [Aa(l)] (0.069), peak
systolic velocity of the lateral motion of the mitral annulus [Sa(l)] (0.095),
• FEV1 [%] was positively correlated with transmitral to basal septal mitral early
diastolic velocity ratio [E/Ea(m)] (0.195), early diastolic velocity of the lateral
motion of the mitral annulus to late diastolic velocity of the lateral motion of the
mitral annulus ratio [Ea/Aa(l)] (0.015)
• FEV1 [%] was negatively correlated with fractional shortening (-0.053), right
ventricular systolic pressure [RVSP] (-0.19), mitral annular velocity during early
diastole [Ea(m)] (-0.019), mitral annular velocity during early diastole to mitral
annular velocity during late diastole ratio [Ea/Aa(m)] (-0.017), transmitral to mitral
annular early diastolic velocity ratio [E/Ea(l)] (-0.103).

22. CORRELATION OF FVC% WITH
ECHOCARDIOGRAPHIC PARAMETERS
• FVC [%] was positively correlated with RV diameter (0.089), early mitral inflow velocity [E]
(0.015), late mitral inflow velocity [A] (0.053), E/A ratio (0.054),
• FVC [%] was positively correlated with TR max jet velocity [TRvmax] (0.096), tricuspid
regurgitant velocity [TR] (0.138), right ventricular systolic pressure [RVSP] (0.217), mitral
annular velocity during late diastole [Aa(m)] (0.030), late diastolic velocity of the lateral motion
of the mitral annulus [Aa(l)] (0.007), transmitral to basal septal mitral early diastolic velocity
ratio [E/Ea(m)] (0.119),
• FVC [%] was negatively correlated with fractional shortening (-0.057),ejection fraction [EF] (-
0.020), mitral annular velocity during early diastole [Ea(m)] (-0.198), peak systolic mitral
annular velocity [Sa(m)] (-0.093), early diastolic velocity of the lateral motion of the mitral
annulus [Ea(l)] (-0.089), peak systolic velocity of the lateral motion of the mitral annulus [Sa(l)]
(-0.027),
• FVC [%] was negatively correlated with mitral annular velocity during early diastole to mitral
annular velocity during late diastole ratio [Ea/Aa(m)] (-0.017), early diastolic velocity of the
lateral motion of the mitral annulus to late diastolic velocity of the lateral motion of the mitral
annulus ratio [Ea/Aa(l)] (-0.059), transmitral to mitral annular early diastolic velocity ratio
[E/Ea(l)].(-0.052)

23. CORRELATION OF FEV1/FVC WITH
ECHOCARDIOGRAPHIC PARAMETERS
• FEV1/FVC [%] was positively correlated with RV diameter (0.030), ejection fraction [EF]
(0.107), early mitral inflow velocity [E] (0.092), late mitral inflow velocity [A] (0.135) E/A ratio
(0.001).
• FEV1/FVC [%] was positively correlated with TR max jet velocity [TRvmax] (0.014), tricuspid
regurgitant velocity [TR] (0.054), early diastolic velocity of the lateral motion of the mitral
annulus [Ea(l)] (0.169), late diastolic velocity of the lateral motion of the mitral annulus [Aa(l)]
(0.097), peak systolic velocity of the lateral motion of the mitral annulus [Sa(l)] (0.135).
• FEV1/FVC [%] was positively correlated with mitral annular velocity during early diastole to
mitral annular velocity during late diastole ratio [Ea/Aa(m)] (0.017), transmitral to basal
septal mitral early diastolic velocity ratio [E/Ea(m)] (0.116), early diastolic velocity of the
lateral motion of the mitral annulus to late diastolic velocity of the lateral motion of the
mitral annulus ratio [Ea/Aa(l)] (0.081),
• FEV1/FVC percent was negatively correlated with fractional shortening (-0.019), right
ventricular systolic pressure [RVSP] (-0.51), mitral annular velocity during early diastole
[Ea(m)] (-0.020), mitral annular velocity during late diastole [Aa(m)] (-0.031), peak systolic
mitral annular velocity [Sa(m)] (-0.08), transmitral to mitral annular early diastolic velocity
ratio [E/Ea(l)] (-0.096)

24. CORRELATION OF PEFR% WITH
ECHOCARDIOGRAPHIC PARAMETERS
• PEFR [%] was positively correlated with RV diameter (0.005), late diastolic velocity of the
lateral motion of the mitral annulus [Aa(l)] (0.174), transmitral to basal septal mitral early
diastolic velocity ratio [E/Ea(m)] (0.139),
• PEFR [%] was negatively correlated with fractional shortening [FS%] (-0.423), ejection
fraction[EF] (-0.320), early mitral inflow velocity [E] (-0.176), late mitral inflow velocity [A] (-
0.205), E/A ratio (-0.235),
• PEFR [%] was negatively correlated with TR max jet velocity [TRvmax] (-0.245), tricuspid
regurgitant velocity [TR] (-0.277), right ventricular systolic pressure [RVSP] (-0.197), mitral
annular velocity during early diastole [Ea(m)] (-0.288), mitral annular velocity during late
diastole [Aa(m)] (-0.174), peak systolic mitral annular velocity [Sa(m)] (-0.132), early diastolic
velocity of the lateral motion of the mitral annulus [Ea(l)] (-0.199), peak systolic velocity of
the lateral motion of the mitral annulus [Sa(l)] (-0.141),
• PEFR [%] was negatively correlated with mitral annular velocity during early diastole to mitral
annular velocity during late diastole ratio [Ea/Aa(m)] (-0.102), early diastolic velocity of the
lateral motion of the mitral annulus to late diastolic velocity of the lateral motion of the
mitral annulus ratio [Ea/Aa(l)] (-0.111), transmitral to mitral annular early diastolic velocity
ratio [E/Ea(l)] (-0.177).

25. TABLE : THE MEAN AND STANDARD DEVIATION OF PFT AND
ECHOCARDIOGRAPHIC PARAMETERS IN CASES VS CONTROL
Parameters` Control Case Mean difference 95% CI of difference
SBP 117.92 ± 8.93 128.24 ± 9.63 10.32 6.63 – 14.0
DBP 78.28 ± 4.55 79.68 ± 7.67 1.40 -3.90 – 1.10
BMI 25.99 ± 5.36 20.58 ± 4.42 5.41 3.46 – 7.36
HB 11.69 ± 1.80 12.47 ± 1.61 0.78 0.09 – 1.45
PCV 33.46 ± 6.58 36.68 ± 4.82 3.23 0.93 – 5.52
FEV1 86.24 ± 12.64 36.80 ± 9.93 49.44 44.93 – 53.95
FVC 97.32 ± 9.32 63.80 ± 14.66 33.52 28.64 – 38.39
FEV1/FVC 88.53 ± 9.13 57.99 ± 10.23 30.53 26.68 – 34.37
PEFR 1.88 ± 0.40 2.72 ± 2.0 0.85 0.27 – 1.42
RV 15.22 ± 3.74 29.09 ± 5.07 13.87 12.10 – 15.64
FS 37.22 ± 4.66 36.04 ± 12.86 1.18 -2.65 – 5.02
EF 57.97 ± 5.76 60.35 ± 10.61 2.37 -5.79 – 1.04
E 0.73 ± 0.06 0.50 ± 0.15 0.23 0.18 – 0.27
A 0.73 ± 0.05 0.71 ± 0.14 0.02 -0.02 – 0.06
E/A 1.0 ± 0.05 0.73 ± 0.14 0.27 0.24 – 0.31
TRV max 0.58 ± 0.10 2.03 ± 0.82 1.45 1.22 – 1.68
TR 6.37 ± 1.41 16.87 ± 13.59 10.50 6.67 – 14.34
RVSP 11.39 ± 0.45 29.11 ± 17.32 17.72 12.86 – 22.59
Ea(m) 0.08 ± 0.01 0.07 ± 0.01 0.009 0.003 - 0.01
Aa(m) 0.09 ± 0.02 0.094 ± 0.02 0.007 0.001 – 0.015
Sa(m) 0.093 ± 0.02 0.07 ± 0.02 0.02 0.014 – 0.027
Ea(I) 0.14 ± 0.02 0.07 ± 0.03 0.065 0.056 – 0.074
Aa(I) 0.12 ± 0.02 0.11 ± 0.02 0.015 0.006 – 0.023
Sa(I) 0.10 ± 0.02 0.08 ± 0.02 0.027 0.019 – 0.035
Ea/Aa(m) 0.93 ± 0.26 0.75 ± 0.27 0.17 0.065 – 0.28
E/Ea (m) 9.72 ± 1.55 7.64 ± 2.90 2.08 1.16 – 3.0
Ea/Aa(I) 1.17 ± 0.26 0.68 ± 0.32 0.49 0.37 – 0.60

26. • The mean and standard deviation for systolic blood pressure [SBP] was
128.24(±9.63) and 117.92 (±8.93), for diastolic blood pressure [DBP] was
79.68(±7.67) and 78.28 (±4.55) for case and control group respectively.
• The mean and standard deviation for body mass index [BMI] was 20.58(±4.42) and
25.99 (±5.36) for case and control group respectively.
• The mean and standard deviation for hemoglobin [Hb%] was 12.47(±1.61) and
11.69 (±1.80), for packed cell volume [PCV] was 36.68(±4.82) and 33.46 (±6.58) for
case and control group respectively.
• The mean and standard deviation for forced expiratory volume in 1 second
[FEV1%] was 36.80(±9.93) and 86.24 (±12.64), for forced vital capacity [FVC] was
63.80(±14.66) and 97.32 (±9.32), for FEV1/FVC was 57.99(±10.23) and 88.53
(±9.13), for peak expiratory flow rate was 2.72(±2.0) and 1.88 (±0.40) for case and
control group respectively.
• The mean and standard deviation for RV diameter [RV] was 29.09(±5.07) and 15.22
(±3.74), for fractional shortening [FS%] was 36.04(±12.86) and 37.22 (±4.66) for
ejection fraction [EF%] was 60.35(±10.61) and 57.97(±5.76) for case and control
group respectively.
• The mean and standard deviation for early mitral inflow velocity [E] was
0.50(±0.15) and 0.73(±0.06), for late mitral inflow velocity [A] was 0.71(±0.14) and
0.73(±0.05), for E/A ratio was 0.73(±0.14) and 1.0(±0.05) for case and control
group respectively.

27. • The mean and standard deviation for TR max jet velocity [TRvmax] was 2.03(±0.82)
and 0.58(±0.10), for tricuspid regurgitant velocity [TR] was 16.86(±13.59) and
6.37(±1.41), for right ventricular systolic pressure [RVSP] was 29.11(±17.32) and
11.39(±0.45) for case and control group respectively.
• The mean and standard deviation for mitral annular velocity during early diastole
[Ea(m)] was 0.07(±0.01) and 0.08(±0.01), for mitral annular velocity during late
diastole [Aa(m)] was 0.094(±0.02) and 0.09(±0.02),for peak systolic mitral annular
velocity [Sa(m)] was 0.07(±0.02) and 0.093(±0.02) for case and control group
respectively.
• The mean and standard deviation for early diastolic velocity of the lateral motion
of the mitral annulus [Ea(l)] was 0.07(±0.03) and 0.14(±0.02), for late diastolic
velocity of the lateral motion of the mitral annulus [Aa(l)] was 0.11(±0.02) and
0.12(±0.02) ,for peak systolic velocity of the lateral motion of the mitral annulus
[Sa(l)] was 0.08(±0.02) and 0.10(±0.02) for case and control group respectively.
• The mean and standard deviation for mitral annular velocity during early diastole
to mitral annular velocity during late diastole ratio [Ea/Aa(m)] was 0.75(±0.27) and
0.93(±0.26), for early diastolic velocity of the lateral motion of the mitral annulus
to late diastolic velocity of the lateral motion of the mitral annulus ratio [Ea/Aa(l)]
was 0.68(±0.32) and 1.17 (±0.26) for case and control group respectively.
• The mean and standard deviation for transmitral to basal septal mitral early
diastolic velocity ratio [E/Ea(m)] was 7.64(±2.90) and 9.72(±1.55), for transmitral to
mitral annular early diastolic velocity ratio [E/Ea(l)] was 7.97(±3.01) and
5.46(±0.79) for case and control group respectively.

28. TABLE : CORRELATION OF PFT AND ECHOCARDIOGRAPHIC
PARAMETERS OF CASES AND CONTROL SUBJECTS
Parameter Pearson Correlation coefficient
FEV1 0.096
FVC -0.072
FEV1/FVC 0.0415
PEFR 0.146
RV -0.032
FS% 0.111
EF% 0.210
E 0.193
A 0.233
E/A -0.270
TRvmax 0.063
TR 0.096
RVSP 0.095
Ea(m) -0.241
Aa(m) -0.121
Sa(m) -0.106
Ea(l) -0.031
Aa(l) 0.055
Sa(l) 0.077
Ea/Aa(m) -0.038
E/Ea(m) -0.106
Ea/Aa(l) -0.072
E/Ea(l) 0.007

29. • PEFR of case group was positively correlated with that of control group (0.146)
• Fractional shortening [FS%] of case group was positively correlated with control
group.(0.111)
• Ejection fraction [EF%] of case group was positively correlated with control group.
(0.210)
• Eearly mitral inflow velocity [E] of case group was positively correlated with control
group. (0.193)
• Late mitral inflow velocity [A] for the case group was positively correlated with
that of control group. (0.233)
• The E/A ratio for case group was negatively correlated with that of control group. (-
0.270)
• Mitral annular velocity during early diastole [Ea(m)] of the case group was
negatively correlated with that of control group.(-0.241)
• Mitral annular velocity during late diastole [Aa(m)] for the case group was
negatively correlated with that of control group.(-0.121)
• Peak systolic mitral annular velocity [Sa(m)] of the case group was negatively
correlated with that of control group.(-0.106)
• Transmitral to basal septal mitral early diastolic velocity ratio [E/Ea(m)] of case
group was negatively correlated with that of control group.(-0.106)

30. DISCUSSION
Studies Mean FEV1 Mean FEV1/FVC
Prasanta Mohapatra et al[3] 42.5±14 54.86±4.04
Present study 36.80 ± 9.93 57.99 ± 10.23
FEV1 and FEV1/FVC
Table : Spirometeric parameters compared with other studies
In the present study the mean FEV1 and FEV1/FVC was comparable to Prasanta R
Mohapatra et al study.
Distribution of patients according to COPD severity grading
In our study it was found that of total 50 patients in case group 8 (16%) patients had
moderate grade COPD (FEV1 50-79%) [3 M; 5: F]. 30 (60%) patients had severe grade
COPD (FEV1 30-49%) [17: M; 13: F]. 12 (24%) had very severe grade COPD (FEV1 ≤30%)
[6: M; 6: F]
In study conducted by Jain B.K. et al out of 80 patients 42 (52.5%) patients had
moderate grade COPD, 26 (32.5%) patients had severe grade COPD, and 12 (15%)
patients had very severe grade COPD.[6]
COPD severity grading in our study was statistically correlated with the study by Jain B.K.
et al [P-value- 0.0001]

31. • Pulmonary artery pressure and correlation with
COPD
• Gupta N. K. et al shown that severe PAH is
present in severe or very severe COPD and the
incidence of PAH is directly proportional to
severity of disease.[7] In a study by Higham MA et
al. 25% patients had mild pulmonary
hypertension while 75% patients had moderate
to severe pulmonary hypertension.[5]
• In our study pulmonary hypertension was
strongly associated with COPD severity [‘p’ value-
0.0326], which is in accordance with previous
studies

32. DIASTOLIC DYSFUNCTION
• Caram LM et al showed that chronic obstructive pulmonary
disease (COPD) patients have a high prevalence of diastolic
dysfunction according to disease severity. [8]
• Sanchez LM et al showed that the prevalence of LVDD in
patients with severe COPD was high, as assessed by
standard echocardiographic measurements, even in the
younger patients group and regardless of lack of systemic
hypertension. [9]
• In our study diastolic dysfunction was statistically not
correlated with COPD severity [‘p’ value-0.650] which is not
in accordance with previous studies.

33. SYSTOLIC DYSFUNCTION
• Rabab A. EL Wahsh et al showed that left
ventricular diastolic function and LV systolic
function are affected in COPD patients especially
with progression of the disease. [10] COPD
patients with pulmonary hypertension are more
liable to LV diastolic and systolic dysfunction than
normal pulmonary pressure COPD patients.
• In our study systolic dysfunction was statistically
not correlated with COPD severity [‘p’ value:
0.283]

34. COMPARISON OF TISSUE DOPPLER
IMAGING PARAMETERS WITH OTHER
STUDIES
• In a study conducted by Ozben B. et al they found out that COPD severity has a
negative impact on RV function, and TDI derived variables for RV function may be
used in the assessment of subclinical RV dysfunction in patients with severe
COPD.[11]
• Ugurlu A.O. et al in another study concluded that RV diastolic dysfunction, which
may not be detected by conventional echocardiography techniques including M-
mode, two-dimensional and spectral Doppler, can be determined by TDI from
different segmental levels in patients with COPD even in the absence of PHT.[12]
• Necla Özer et al reported that with COPD, the development of pulmonary
hypertension leads to right ventricular dilation, right ventricular systolic and
diastolic dysfunction, and left ventricular diastolic dysfunction, whereas the
patients without pulmonary hypertension are spared from right and left
ventricular dysfunction.[13]
• We have compared the data of tissue doppler imaging (TDI) with these studies and
found out that tissue doppler imaging (TDI) parameters from our study were fairly
correlated with previous studies

35. TABLE : TDI PARAMETERS COMPARED WITH
OTHER STUDIES
TDI parameters Present study Necla Özer et
al[13]
A.O. Ugurlu et
al[12]
Beste Ozben et
al[11]
RV 29.09±5.07 40.4±11.2 32.0±3.0 38.0±7.8
FS% 36.04±12.86 NM 37.7±5.7 NM
EF% 60.35±10.61 NM 55.6±5.5 58.4±10.02
E 0.50±0.15 0.31±0.50 0.61±0.12 0.70±0.24
A 0.71±0.14 0.54±0.15 0.78±0.18 0.82±0.19
E/A 0.73±0.14 0.61±0.16 NM 0.85±0.39
TRvmax 2.03±0.82 NM NM NM
RVSP 29.11±17.32 NM NM 40.0±13
Ea(m) 0.08±0.11 NM 0.19±0.92 0.10±0.30
Aa(m) 0.09±0.02 NM 0.26±0.69 0.16±0.39
Sa(m) 0.09±0.02 NM 0.23±0.92 0.12±0.27
Ea(l) 0.14±0.02 NM 0.13±0.46 NM
Aa(l) 0.12±0.02 NM 0.17±0.56 NM
Sa(l) 0.10±0.02 NM 0.15±0.31 NM
Ea/Aa(m) 0.93±0.26 NM NM 0.71±0.27
E/Ea(l) 9.72±1.55 NM NM NM
Ea/Aa(l) 1.17±0.26 NM NM NM
E/Ea(l) 5.46±0.79 NM NM NM

36. COMPARISON OF SPIROMETRIC PARAMETERS
WITH ECHOCARDIOGRAPHY
• Das M et al in their study found that there was strong
negative correlation of Systolic Pulmonary Artery Pressure
(SPAP) with FEV1/FVC ratio (r = -0.5553) and PEFR (r = -
0.4604). They concluded that tissue Doppler imaging can be a
vital prognostic sign to predict RV dysfunction and predict
morbidity in COPD.[14]
• In our study There was negative correlation between
pulmonary artery pressure and FEV1 (-0.19), FEV1/FVC ratio (-
0.51), and PEFR (-0.197).

37. CONCLUSIONS
• Pulmonary function tests namely FEV1, FVC,
FEV1/FVC were significantly deranged in case
group as compared with control group.
• Lung function parameters namely FEV1, FVC,
FEV1/FVC and PEFR have significant inverse
correlation with the severity of COPD.
• RV diameter and RVSP were significantly
increased in patients with COPD as compared
with control group.

38. CONCLUSIONS
• RV wall thickness was positively correlated with
duration and severity of COPD.
• Significant number of patients with COPD had
diastolic dysfunction.
• Early detection of pulmonary hypertension is
important for therapeutic and prognostic purposes.
• Echocardiography helps in early detection of cardiac
changes secondary to COPD providing time for early
intervention.
• Tissue Doppler imaging is an important tool for
diagnosis of subclinical RV and LV dysfunction.
(systolic and diastolic dysfunction)

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42. THANK YOU