Emerging role of transesophageal echocardiography in severe chronic obstructive pulmonary disease

Ashwin Songara, Nikhilesh Pasari, Arpita Ajmera, Kapil Jangid, Divya Malpani, Mriganka Madhab Misra


Background: Pulmonary hypertension (PH) secondary to chronic obstructive pulmonary disease (COPD) has a prevalence from 20 to 91% depending on the definition of PH (mPAP >20 versus >25 mmHg). Pulmonary vasoconstriction, pulmonary vascular remodeling, endothelial dysfunction, inflammation and destruction of the pulmonary vascular bed being the common mechanisms behind. Transthoracic echocardiograms (TTE) though the most important non-invasive tool to measure degree of PH, may give false negative results in severe COPD cases due to poor echo window. This could be overcome by doing transesophageal echocardiograms (TEE) in those cases, which is, though invasive but gives good results. The aim of the study was to evaluate the role of transesophageal echocardiography in COPD patients.

Methods: Total 100 patients of COPD were evaluated for PH via TTE and TEE was performed in all those 33 patients whose TTE were non-confirmatory due to poor echo window.

Results: There were 0% patient with poor echo window in COPD grade 1, 18.18% in grade 2, 42.2% and 39.39% in grade 3 and grade 4 respectively. P-value obtained was statistically significant P <0.001. Out of 33 COPD patients with poor echo window, In grade 3 and grade 4, 64.2% and 76.9% patients had TEE findings respectively while in grade1 and grade 2 0% and 33.33% patient had TEE finding.

Conclusions: TTE though is an excellent tool for diagnosing  pulmonary artery hypertension in COPD patients, has its limitation especially in severe COPD cases due to poor echo window which may give false negative results. So TEE should be recommended in all those severe COPD cases that have poor echo window.



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Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163:1256-76.

Celli BR, Macnee W, Commitee members. Standard for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932-46.

Barnes PJ, Kleinert S. COPD-a neglected disease. Lancet. 2004;364:564-5.

Robert N, Joan AB. Pulmonary hypertension associated with COPD. Critical Care. 2001.5(6):286-9.

Chhabra SK. Pulmonary hypertension associated with chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci. 2010;52:29-40.

Han MK, Mclaughlin VV, Criner GH, Martinez FJ. Pulmonary diseases and the heart. Circulation 2007;116(25):2992-3005.

Sidebotham D, Merry A, Legget M, editors. Practical perioperative transesophageal echocardiography, London, Buttorworth, Heinemaan. 2003;117-129.

Shanewise, Shanewise JS, Cheung AT, Aronson S, Stewart WJ, Richard L, et al. ASE/SCA intraoperative TEE guidelines. Anethes Analg. 1999;89:870-84.

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

Putnik M, Povazan D, Vindis JM. Electrocardiography and echocardiography in the diagnosis of chronic cor pulmonale. Med Pregl. 1998;51(11):528-31.

Vikhe V, Shende PS, Patil RS, Tamakuwala KK, Patil AS, Gupta AP. Cardiovascular complications in chronic obstructive pulmonary disease with reference to 2D echocardiography findings. National J Med Res. 2013;3(4):385-8.

Howard LS, Grapsa J, Dawson D, Bellamy M, Chambers MB, Masani ND, et al. Echocardiographic assessment of pulmonary hypertension: standard operating procedure. Eur Respir Rev. 2012;21(125):239-48.

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

Kitabatake A, Inoue M, Asao M, Masuyama T, Tanouchi J, Morita T et al. Non-invasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation. 1983;68(2):302-9.

Gupta NK, Agrawal RK, Srivastav AB, Ved ML. Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease. Lung India. 2011;28(2):105-9.

Lawlor DA, Ebrahim S, Davey SG. Association between self-reported childhood socioeconomic position and adult lung function: findings from the British females’s Heart and Health Study. Thorax. 2004;59:199-203.

Dave L, Dwivedi P, Srivastava N, Yadav BS, Dohre R. A study of cardiovascular manifestations of COPD. Int J Res Health Sci. 2014;2(3):812-7.