Clinical and phonocardiographic evaluation of left ventricular function in patients with chronic obstructive pulmonary disease

Shankar Vasista, Govind Bhattad


Background: Chronic obstructive pulmonary disease (COPD) is a term to describe a group of diseases (chronic bronchitis and emphysema). The status of left ventricular (LV) function in patients with COPD has been a controversial subject. Given the ambiguity in correlation of LV dysfunction and COPD, this study was planned to assess the relationship between LV function and COPD.

Methods: This was an observational study done in 40 adult patients with acute exacerbation of COPD. The enrolled patients were divided into 2 major groups. Group A - predominant emphysema and Group B - predominant bronchitis. Phonocardiogram (PCG), carotid pulse tracing and ECG were done to measure LV ejection time (LVET) and pre-ejection period (PEP).

Results: FEV1 impairment was greater (severe to very severe grade) in the majority (77%) of patients of group B, whereas the majority (77.2%) of group A patients had lesser degree of FEV1 impairment (mild to moderate). PEPI were observed to be prolonged and LVETI were observed to be shortened. PEP/LVET ratio was observed to be prolonged in 77.5% of patients in stable condition. PEP/LVET ratio was abnormally prolonged (>0.42) to a greater extent in patients of group B than in patients of group A.

Conclusions: LV dysfunction is commonly encountered in patients with COPD and was observed to be exaggerated during an acute exacerbation. It was maximum in patients with chronic bronchitis with cor pulmonale with CCF and lesser in patients with chronic bronchitis without cor pulmonale or CCF and least in patients with emphysema.


Chronic obstructive pulmonary disease, Left ventricular dysfunction, Systolic time intervals

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Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J. 2008;32(5):1371-85.

Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: Physiology and anesthetic implications. Anesthesiol. 2015;122:932-946.

Elwing J, Panos RJ. Pulmonary hypertension associated with COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(1):55-70.

Hooper RG, Whitcomb ME. Systolic time intervals in chronic obstructive pulmonary disease. Circulation. 1974;50:1205-9.

Weissler AM. Reviews of contemporary Laboratory Methods. A critical review of the systolic time intervals. Circulation. 1977;56(2):146-58.

Weissler AM, Harris WS. Bedside techniques for the evaluation of ventricular function in man. Am J. Cardiol. 1969;23:577.

Alpert JS, Rickman FD, Howe JP, Dexter L, Dalen JE. Alteration of systolic time intervals in right ventricular failure. Circulation. 1974;50:317-23.

Lewis RP, Leighton RF, Weissler AM. Systolic time intervals in noninvasive cardiology. Editors; Weissler AM New York, Grune and Stratton. 1974:301-368.

Pande JN. Chronic obstructive lung disease. API Text book of Medicine 4th ed. 283-7.

Thurlback WM. Chronic obstructive Lung Disease. Clinical study Med. 1970;49(2):81-141.

Will J. Occupational pulmonary disease in pulmonary diseases and disorders 2nd ed. A.P. Fishman (ed) New York, Mc Graw Hill; 1987 chap. 54.

Hume R. Blood volume changes in chronic bronchitis and emphysema. Br. J. Haematol. 1968;15(2):131.

Calverlgy PM, Leggett RJ, McEderry L, Flenley DC. Cigarette smoking and secondary Polycythemia in hypoxic cor pulmonale. Am. Rev. Resp. Dis. 1982;125(5):507-10.

Michelson N. Bilateral ventricular hypertrophy due to chronic pulmonary disease. Dis Chest. 1960;38:435.

Fluck DC, Chandrasekar RG, Gardner. Left ventricular hypertrophy in chronic bronchitis. Br Heart J. 1966;28(1):92.

Rao BS, Cohn KE, Eldridge FE, Hancock EW. Left ventricular failure secondary to chronic pulmonary disease. Aspen Emphysema Conf. 1968;11:129-34.

Khaja F, Parker JO. Right and left ventricular performance in chronic obstructive lung disease. Am Heart J. 1971;82(3):319.

Davies H, Overy H. Left ventricular function in cor pulmonale. Chest. 1970;58 (1):8.

Williams FJ, Childress RH, Boyd DL, Higgs LM, Behnke RH. Left ventricular function in patients with chronic obstructive pulmonary disease. The Jour of Clin invest. 1968;47(5):1143.

Scott RW, Garvin CF. Cor pulmonale observations in 50 autopsy cases. Am Heart J. 1941;22(1):56-63.

Spain D, Handler BJ. Chronic cor pulmonale sixty cases studied at necropsy. JAMA. 1946;77:37-65.

Zimmerman HA, Ryan JM. Cor pumonale. Dis chest. 1951;20:286.

Martin CE, Shaver JA, Thompson ME, Reddy SP, Leonard JJ. Direct correlation of ext. systolic time intervals with internal indices of left ventricular function in man. Circulation. 1971;44(3):419-31.

Van de Werf F, Piessens J, Kesteloot H, De Geest HA. Comparison of systolic time intervals derived from the central aortic pressure and from the ext. carotid tracing. Circulation. 1975.51(2):310-6.

Weissler AM, Harris WS, Schoenfeld CD. Systolic time intervals in heart failure in man. Circulation. 1968;37(2):149-59.

Filley GF, Beckwitt HJ, Reeves JT, Mitchell RS. Chronic obstructive bronchopulmonary disease-II Oxygen transport in two clinical types, Am J Med. 1968;44(1):26-38.