A Study About The Relationship Between The Impairment Of Lung Function And The Damage Of Right Heart In Different Stages Of Patients With Chronic Obstructive Pulmonary Disease

Objective To clarify the relationship between the impairmant of lung function and the chang of cardiac structure or pulmonary artery pressure in different stages of patients with chronic obstructive pulmonary disease (COPD).Methods 133 COPD patients (male 114,female 19, aged 51-84 years, mean age 71.8±8.4 years) and 31 healthy controls (male 26 and female 5,aged 52～81 years, mean age 68.1±9.2 years) were selected from the First Hospital of Lanzhou University. All cases lung function and pulmonary artery systolic pressure (PASP) and right cardiac structure were measured by spirometry and Color Doppler echocardiography.Results(1)①With the worse degree of lung function generally, the BMI of COPD patients was decreased generally. The BMI in stageⅣ(19.2±2.5)of COPD patients was less than in healthy control (25.0±2.9) and StageⅠ(26.4±3.7), StageⅡ(24.9±4.1),StageⅢ(23.4±4.6) of COPD patients (P all<0.01).②Respiratory failure was existed in stageⅢand stageⅣof COPD patients. The PaO2 in stageⅢI (49.45±12.86) mmHg or stageⅣ(45.80±13.7) mmHg of COPD patients was respectively less than in stageⅠ(59.00±8.97) mmHg, stageⅡ(59.00±10.44) mmHg (P all<0.05).(2)①With the degree of lung function abnormality generally, the FEV1%, FEV1/FVC, FVC,MVV of COPD patients was decreased gradually.The FEV1%in stageⅠto stageⅣof COPD patients respectively (88.95±10.93)%, (64.68±9.1)%,(39.98±5.32)%,(23.94±3.51)%and FEV1/FVC in stageⅠto stageⅣof COPD patients respectively (63.73±4.53)%,(55.34±14.58)%,(48.45±8.28)%, (39.69±7.59)% were obviously less than in healthy controls respectively (104.87±11.39)%,(77.36±4.83)%,(P all<0.01),and the differences among stageⅠ,Ⅱ,Ⅲ,Ⅳof COPD patients were existed (P<0.01 or P<0.05). The FVC in stageⅢ(2.03±0.59) L, stageⅣ(1.72±0.38) L of COPD patients was respectively less than in healthy controls(3.23±0.88)L and stageⅠ(3.39±0.85) L, stageⅡ(2.49±0.55) L of COPD patients (P<0.01 or P<0.05).The MVV in stageⅡto stageⅣof COPD patients respectively (50.7±19.44) L,(33.95±14.67) L, (24.23±4.34) L was obviously less than in healthy controls (92.89±23.48) L (P all<0.01) and the differences among stageⅡ,Ⅲ,Ⅳof COPD patients were existed (P<0.01 or P<0.05).②With the worse degree of lung function generally, the FEF25%, FEF50%,FEF75%,FEF25%-75% of COPD patients were decreased generally, they were lower than in healthy controls (P <0.01 or P<0.05).The FEF25% in stageⅢ(0.12±0.08) L/S,stageⅣ(0.10±0.07) L/S was respectively lower than stage I (0.31±0.24) L/S of COPD patients(P all<0.05). The FEF50% in stageⅢ(0.39±0.17) L/S, stageⅣ(0.29±0.24) L/S was significantly lower than in stageⅠ(1.19±0.54) L/S, stageⅡ(0.77±0.26) L/S of COPD patients (P all<0.01).The FEF75% in stageⅢ(0.97±0.47) L/S,stageⅣ(0.46±0.10) L/S was significantly lower than in stageⅠ(3.49±1.32) L/S, stageⅡ(2.14±0.91) L/S of COPD patients (P all<0.01).The FEF25%-75%in stageⅢ(0.31±0.11) L/S, stageⅣ(0.20±0.08) L/S was significantly lower than in stageⅠ(0.83±0.30) L/S, stageⅡ(0.51±0.16) L/S of COPD patients (P all<0.01), and there was significantly difference between stageⅢand stage IV of COPD patients (P all<0.01).The PEF in stageⅡ(4.05±1.52) L/S, stageⅢ(2.96±0.99) L/S, stageⅣ(2.43±0.90) L/S of COPD patients was lower than in healthy controls (6.55±1.75) L/S, stageⅠ(6.47±1.73) of COPD patients (P<0.01 or P<0.05).③TLC in stageⅠ(6.06±1.21) L of COPD patients was higher than in healthy controls (5.31±1.05) L (P<0.05).With the worse degree of lung function generally, the RV and RV/TLC of COPD patients were increased generally. The RV in stageⅠto stageⅣand the RV/TLC in stageⅡto stage IV of COPD patients were all higher than in healthy controls (P<0.01 or P<0.05). The RV in stageⅣ(3.07±0.68) L was higher than in stageⅡ(2.42±0.61) L, stageⅢ(2.43±0.80) L of COPD patients (P all<0.05).The RV/TLC in stageⅣ(0.59±0.06) was higher than in stageⅠ(0.45±0.07),stageⅡ(0.48±0.09),stageⅢ(0.51±0.10) of COPD patients (P<0.01 or P<0.05).With the worse degree of lung function generally, the IC and IC/TLC of COPD patients were decreased generally. The IC in stage II to stage IV of COPD patients and the IC/TLC in all stages were lower than in healthy controls (P<0.01 or P<0.05).The IC in stageⅢ(1.79±0.61) L, stageⅣ(1.41±0.27) L was lower than in stage I (2.48±1.08) L (P<0.01), stageⅣ(1.41±0.27) L was lower than stageⅡ(1.98±0.47) L of COPD patients (P<0.05).The IC/TLC in stageⅣ(0.25±0.06) was significantly lower than in stageⅠ(0.39±0.15),stageⅡ(0.40±0.08),stageⅢ(0.37±0.09) (P all<0.01).④With the degree of lung function abnormality generally, the DLCOc and DLCOc/VA in stageⅠto stageⅣof COPD patients were decreased generally, and was significantly lower than in healthy controls (P all<0.01).The DLCOc in stageⅢ(2.57±1.87) mmol/min/kPa, stageⅣ(1.79±1.94) mmol/min/kPa was significantly lower than stageⅠ(5.89±2.49) mmol/min/kPa, stageⅡ(4.73±1.71)mmol/min/kPa of COPD patients (P all>0.01).The DLCOc/VA in stageⅢ(0.56±0.34) mmol/min/kPa, stageⅣ(0.35±0.40) mmol/min/kPa was significantly lower than in stageⅠ(1.09±0.38) mmol/min/kPa, stageⅡ(0.97±0.42) mmol/min/kPa (P all<0.01) of COPD patients.⑤With the worse degree of lung function generally, the Zrs, Fres, R5,R5-R20, Rp and absolute value of X5 in stageⅡto stage IV of COPD patients were all increased generally and were all higher than in healthy controls (P<0.01 or P<0.05). The Fres in stageⅣ(35.16±7.15) Hz was significantly higher than in stageⅠ(19.03±6.01) Hz, stageⅡ(22.2±6.54) Hz, stageⅢ(24.52±9.00) Hz of COPD patients (P<0.01).The Rp in stageⅣ(0.78±0.17) kPa·L-1·S-1 was significantly higher than in stageⅠ(0.36±0.23)kPa·L-1·S-1,stageⅡ(0.48±0.28)kPa·L-1·S-1, stageⅢ(0.50±0.26) kPa·L-1·S-1 of COPD patients (P all<0.01).The absolute value of X5 in stage IV (0.46±0.14) kPa·L-1·S-1 was significantly higher than in stageⅠ(0.20±0.11)kPa·L-1·S-1, stageⅡ(0.24±0.13) kPa·L-1·S-1, stageⅢ(0.27±0.18) kPa·L-1·S-1 of COPD patients (P all<0.01).The Zrs in stageⅣ(0.78±0.19)kPa·L-1·S-1 was higher than in stageⅠ(0.49±0.22) kPa·L-1·S-1 of COPD patients (P all<0.01).The R5-R20 in stageⅣ(0.23±0.03)kPa·L-1·S-1 was significantly higher than in stageⅠ(0.14±0.03)kPa·L-1·S-1, stageⅡ(0.17±0.04) kPa·L-1·S-1 of COPD patients (P all<0.01).(3)With the worse degree of lung function generally, the PASP of COPD patients was increased generally. The PASP in stageⅣ (63.73±21.06) mmHg was significantly higher than inⅠ(42.33±4.04) mmHg, stageⅡ(42.92±8.51)mmHg, stageⅢ(55.85±24.81) mmHg (P<0.01), stageⅢwas higher than in stageⅠor stageⅡof COPD patients (P<0.01 or P<0.05). With the degree of lung function abnormality generally, the right ventricular outflow tract, the pulmonary trunk interior diameter, the right ventricular interior diameter, the right atrial interior diameter enlargement and left/right ventricular interior diameter were all widened, especially in stageⅢof COPD patients.The pulmonary trunk interior diameter in stageⅢ(3.25±0.66) cm was wider than in healthy controls (2.57±0.37) cm, stageⅠ(2.85±0.31) cm of COPD patients (P<0.01 or P<0.05). The right ventricular interior diameter in stageⅢ(3.02±0.98) cm was significantly wider than in healthy controls (2.38±0.88) cm,Ⅱ(2.29±0.52) cm of COPD patients (P all<0.01). Right atrial interior diameter in stageⅢ(3.96±0.96) cm was wider than in healthy controls (3.31±0.50) cm, stageⅡ(3.40±0.61)cm of COPD patients (P<0.01 or P <0.05).The right ventricular outflow tract in stageⅢ(3.15±0.44) cm was significantly wider than in healthy controls (2.86±0.33) cm (P<0.01).The left/right ventricular interior diameter in stateⅢ(1.68±0.61)was significantly lower than in healthy controls (2.25±0.34),stateⅠ(2.23±0.41) or stateⅡ(2.12±0.45) of COPD patients (P all<0.01).(4) The Fres, Zrs, R5,R5-R20, X5 absolute value were negatively correlated with FEV1% significantly (r=-0.576,-0.465,-0.407,-0.589,-0.501,-0.500, respectively, P all<0.01).The RV/TLC was negatively correlated with FEV1%(r=-0.342,P<0.05).FVC,FEV1/FVC,MVV, PEF, FEF25%,FEF50%,FEF75%,FEF25%-75%, IC,IC/TLC, DLCOc, DLCOc/VA were positive correlated with FEV1% significantly (r=0.614,0.807,0.791,0.735,0.691,0.814,0.870,0.668,0.418,0.460,0.557,0.570, respectively, P all<0.01).(5)①BMI was positively correlated with FEV1%, FEV1/FVC,DLCOc, DLCOc/VA significantly (r=0.312,0.368,0.443,0.526, respectively, P all<0.01)and with PEF, FEF750% (r=0.213,0.227,respectively, P all<0.05).BMI was negatively correlated with Fres (r=-0.211,P<0.05).②BMI was positively correlated with PaO2(r=0.383,P<0.05)in stateⅢto stateⅣof COPD patients.③For heart structure, BMI was also positively correlated with right ventricular outflow tract (r=0.382,P<0.05) in healthy controls.BMI was also positively correlated with pulmonary trunk interior diameter(r=0.302,P<0.05)and right atrial interior diameter (r=0.278,P<0.05)in COPD patients.(6) PaO2 was also negatively correlated with PASP (r=-0.309,P<0.05)and was also negatively correlated with the pulmonary trunk interior diameter, right ventricular interior diameter significantly (r=-0.347,-0.425,respectively, P all<0.01)in COPD patients. PaO2 was also positively correlated with left/right ventricular interior diameter significantly (r=0.632,P<0.01) in COPD patients.PaO2 was also negatively correlated with the pulmonary trunk interior diameter (r=-0.328,P<0.05) in COPD patients.(7)①FEV1% was negatively correlated with right ventricular outflow tract (r=-0.306, P<0.01)in COPD patient. FEV1/FVC was negatively correlated with right ventricular interior diameter(r=-0.278,P<0.05)in COPD patients.FEV1%,FVC, MVV was positively correlated with left/right ventricular interior diameter (r=0.308, 0.280,0.334,P<0.01 or P<0.05)in COPD patients.②FEF25% was negatively correlated with the pulmonary trunk interior diameter (r=-0.245,P<0.05) in COPD patients.PEF, FEF50% and FEF75% was also positively correlated with left/right ventricular interior diameter (r=0.346,0.266,0.364,respectively, P<0.01 or P<0.05) in COPD patients.③TLC and RV was positively correlated with right ventricular outflow tract (r=0.265,0.316, respectively, P all<0.05)in COPD patients.④DLCOc, DLCOc/VA was also positively correlated with left/right ventricular interior diameter (r=0.391,0.317,respectively, P<0.01 or P<0.05) in COPD patients.⑤Fres, Rp, Zrs, Rs,R5-R20, X5 absolute value was also positively correlated with the pulmonary trunk interior diameter (r=0.238,0.290,0.343,0.364,0.351,0.283,respectively, P<0.01 or P<0.05).Rp, Zrs, R5, R5-R20, absolute value of X5 was also negatively correlated with left/right ventricular interior diameter (r=-0.219,-0.207,-0.204,-0.176,-0.222, respectively, P<0.05).Conclusions The BMI of COPD patients decreased generally with the worse degree of lung function generally. It was indicates that COPD can cause systemic effects.The most impairment of lung function was in stateⅢand stateⅣof COPD patients.Respiratory failure was existed in stageⅢand stage IV of COPD patients. The increase of pulmonary artery systolic pressure was correlated with hypoxia but was not correlated with lung function. With the worse degree of lung function generally in COPD patients,the changes of right ventricular structural appeared most obviously in stageⅢ. The relationship between the impairment of lung function and the damage of right heart was not generalized linearily in patients with COPD...