Evaluation Of The Left And Right Ventricular Function In Patients With Chronic Obstructive Pulmonary Disease Using Real-time Three-dimensional Echocardiography

Chronic obstructive pulmonary disease (COPD) is characterized by anincompletely reversible limitation in airflow, and it is generally a progressivedisease. COPD is a common and frequently-occurring disease in respiratorysystem. And it has high morbidity and mortality. COPD not only affects thepatient's quality of life, but also represents a substantial economic and socialburden throughout the world. COPD can lead to pulmonary arteryhypertension and electrolyte disturbance, which will influence the left andright ventricular function. So, it is important to study COPD patient's left andright ventricular function for early clinical intervention.Real-time three-dimensional echocardiography (RT-3DE), as a newtechnique, can not only evaluate the left and right ventricular volume, but alsodetermine and analyze the movement of different segments of left ventricularmyocardium simultaneously and quantitatively.In this study, RT-3DE was used to evaluate the left and right ventricularfunction, to investigate the clinical value of RT-3DE. There are two parts inthis study. The first part is to evaluate the changes of the right ventricularfunction of patients with chronic obstructive pulmonary disease (COPD),using real-time three-dimensional echocardiography (RT-3DE). The secondpart is to evaluate the changes of left ventricular function of patients withchronic obstructive pulmonary disease (COPD), using real-timethree-dimensional echocardiography (RT-3DE).Part One:Evaluation of right ventricular function in patientswith chronic obstructive pulmonary disease using real-timethree-dimensional echocardiography Objective: To evaluate the changes of right ventricular function ofpatients with chronic obstructive pulmonary disease (COPD), using real-timethree-dimensional echocardiography (RT-3DE), and to investigate the clinicalvalue of RT-3DE.Methods:32COPD patients and36normal persons were enrolled in thisstudy, to obtain their single cardiac cycle RT-3DE images of right ventricular(RV). And all the RT-3DE images were analyzed quantitatively to generateseries of RV parameters, including RV end diastolic volume (RVEDV), RVend systolic volume (RVESV), RV ejection fraction (RVEF) and RV strokevolume (RVSV).Results: Compared to normal control group, the value of RVEDV andRVESV were significantly larger (all P<0.05); RVEF were reducedsignificantly (P<0.05). The RVSV has no significant difference between thetwo groups(P=0.12).Conclusions:1. Right ventricular volume was enlarged and systolic function wasimpaired in patients with chronic obstructive pulmonary disease. RT-3DE, as anew convenient method, could be used to evaluate the RV function exactly,and it is helpful for early clinical intervention.2. Although the right ventricular volume and systolic function waschanged in chronic obstructive pulmonary disease, the right ventricular strokevolume had no difference with the normal persons. So, RVSV may not be asensitive index to evaluate the function of the right ventricular. Further studiesare needed to fully appreciate this conclusion. Part two: Evaluation of left ventricular function in patients withchronic obstructive pulmonary disease using real-time three-dimensional echocardiographyObjective: To analyze the changes of left ventricle volumetric parameters,systolic synchrony parameters and diastolic synchrony parameters of patientswith chronic obstructive pulmonary disease (COPD), using real-timethree-dimensional echocardiography (RT-3DE). And evaluate COPD patients'left ventricular function.Methods:32COPD patients and36normal persons were enrolled in thisstudy, to obtain their single cardiac cycle RT-3DE images of left ventricular.And all the RT-3DE images were analyzed quantitatively to generate series ofLV parameters, such as left ventricle volumetric parameters, systolicsynchrony parameters and diastolic synchrony parameters. Left ventriclevolumetric parameters including end systolic volume (ESV), end diastolicvolume (EDV), ejection fraction (EF), stroke volume (SV), end-systolicsphericity index(ESSI), end-diastolic sphericity index(EDSI). Systolicsynchrony parameters including systolic dyssynchrony index (the16-segmentmodel)(SDI16), dispersion end-systole (the16-segment model)(DISPES16),pre-contraction time volume (the16-segment model)(PreContr16), andpost-contraction time volume (the16-segment model)(PostContr16) andmean end-systolic time (the16-segment model)(MES16). Diastolic synchronyparameters including diastolic dyssynchrony index (the16-segment model)(DDI16), dispersion end-diastole (the16-segment model)(DISPED16),pre-relaxaction time volume (the16-segment model)(PreRelax16),post-relaxaction time volume (the16-segment model)(PostRelax16) andmean end-diastolic time (the16-segment model)(MED16).Results:1. In the left ventricle volumetric parameters, compared to normal controlgroup, the value of LVESV,LVEDV were significantly larger (all P<0.05);LVEF were reduced significantly (P<0.05). The LVSV,ESSI,EDSI has nosignificant difference between the two groups(all P>0.05).2. In the systolic synchrony parameters, PreContr16,MES16of the COPD group were significantly larger than the normal group(all P<0.05);SDI16,DISPES16and PostContr16had no significant difference between thetwo groups(all P>0.05).3. All the diastolic synchrony parameters had no significant differencebetween the two groups(all P>0.05).4. The LVEF of COPD patients is56.74±9.84%, which is lager than theTest Value(P<0.05).Conclusions:1. The left ventricular volume was enlarged in patients with chronicobstructive pulmonary disease,but the ESSI and EDSI had no significantdifference between the two groups. So the whole shape and proportion inpatients with COPD had no change. RT-3DE, as a new convenient method,could be used to evaluate the LV volume exactly.2. The systolic function was also in compensatory zone, and the leftventricular stroke volume could keep the physiological drive of the patientwith chronic obstructive pulmonary disease. But, compared to normal controlgroup, the systolic function was impaired in patients with chronic obstructivepulmonary disease, their whole systolic time was prolonged, and thesegmental systolic pattern was changed.3. The systolic function of the left ventricular myocardium segmentscould be influenced by COPD. But the diastolic function could not be changedin patients with chronic obstructive pulmonary disease, their diastolicsynchrony parameters had no significant difference between the two groups.RT-3DE could be used to analyze the movement of different segments of leftventricular myocardium quantitatively.