Clinical Analysis Of Chronic Obstructive Pulmonary Disease With Left Ventricular Diastolic Dysfunction

ObjectivesChronic obstructive pulmonary disease(COPD)is a common chronic respiratory disease,which is a serious threat to human health.Cardiovascular disease is the most common and important comorbidity of COPD.Heart failure is closely related to mortality,quality of life and exercise tolerance in patients with COPD.Left ventricular diastolic insufficiency is the early stage of left ventricular failure.Its symptoms of dyspnea are easily confused with COPD and are often ignored in clinical practice.The purpose of this study was to evaluate the left ventricular diastolic function in patients with COPD,to analyze the clinical characteristics of COPD with left ventricular diastolic dysfunction,and to explore its clinical significance.We hope that the results can facilitate the early detection and early intervention of left ventricular diastolic insufficiency,thereby to delay the progression of heart failure in patients with COPD.MethodsThis is a cross-sectional,retrospective study.All of the subjects are from the Han population in Shandong Province.From March 2015 to February 2018,patients who were hospitalized in Qilu Hospital of Shandong University with stable COPD were selected.The inclusion criteria were according to GOLD2017 COPD diagnostic criteria and left ventricular diastolic dysfunction criteria,excluding patients with acute exacerbation chronic obstructive pulmonary disease,other lung diseases or major diseases,and the incomplete data affected the judgment.General data of all subjects were collected,including age,gender,height,weight,body mass index(BMI),smoking history,and underlying diseases(coronary atherosclerotic heart disease,hypertension,diabetes,chronic kidney disease).N-terminal brain natriuretic peptide precursor or brain natriuretic peptide,peripheral artery PH value,blood oxygen saturation as well as data from lung function,heart color ultrasound and electrocardiogram were recorded.Unpaired-t test,rank sum test and chi-square test were used to analyze the differences among the variables,and the variables with statistical significance were included in the multivariate logistic regression analysis.All the data were analyzed by software SPSS 22.0,all the statistical tests were carried out by bilateral test,and the difference was statistically significant based on p<0.05.Results1.According to the inclusion criteria and exclusion criteria,303 patients were included in the study,including 126 patients with chronic obstructive pulmonary disease complicated with left ventricular diastolic dysfunction and 177 patients with chronic obstructive pulmonary disease without left ventricular diastolic dysfunction.2.chronic obstructive pulmonary disease complicated with left ventricular diastolic dysfunction has a higher proportion of female(P=0.005),smoking history(P<0.001),hypertension(P<0.001),diabetes(P<0.0O01)and coronary heart disease(P<0.001).They were older(P=0.007),pulmonary artery pressure(P<0.001)and the absolute value of P wave deep terminal force in lead V1(P<0.001)higher than those without left ventricular diastolic dysfunction.There was no significant difference between the two groups in the severity of pulmonary dysfunction(P=0.395)and mMRC score(P=0.841).3.Binary logistic regression analysis showed that age(P=0.029),female(P=0.016),BMI(P=0.005),pulmonary artery pressure(P<0.001),smoking history(P=0.012),hypertension(P=0.011),diabetes(P=0.002),coronary heart disease history(P=0.046)were associated with left ventricular diastolic dysfunction in patients with COPD.4.The absolute value of P wave deep terminal force in lead V1 of patients with left ventricular diastolic dysfunction is larger than those without left ventricular diastolic dysfunction.The area under the roc curve for ptfv1 is 0.706,the 95%confidence interval is[0.466,0.765g],and the standard deviation is 0.030,p<0.001.The optimum critical value is 0.0299,the sensitivity is 0.714,and the specificity is 0.695.Conclusion1.The ratio of left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease is relatively high,which should arouse clinicians' full attention and vigilance.2.Patients with chronic obstructive pulmonary disease complicated with left ventricular diastolic dysfunction was associated with older age,higher proportion of female,higher BMI,higher pulmonary artery pressure,smoking history,hypertension,coronary heart disease and diabetes.3.P wave deep terminal force in lead VI may be a simple and effective index for evaluating left ventricular diastolic dysfunction in COPD patients.