Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trials
Background Hypoxic pulmonary vasoconstriction leads to an increase in pulmonary artery pressure (PAP) and potentially right heart failure in healthy individuals and patients with respiratory diseases. Previous studies in patients with chronic obstructive pulmonary disease (COPD) exposed to hypobaric...
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BMJ Publishing Group
2025-01-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e002837.full |
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| author | Konrad E Bloch Mona Lichtblau Silvia Ulrich Felix C Tanner Talant Sooronbaev Maamed Mademilov Michael Furian Helga Preiss Laura Mayer Simon Rafael Schneider Julian Müller Stephanie Saxer Anna Titz Anwer Shehab Lena Reimann |
| author_facet | Konrad E Bloch Mona Lichtblau Silvia Ulrich Felix C Tanner Talant Sooronbaev Maamed Mademilov Michael Furian Helga Preiss Laura Mayer Simon Rafael Schneider Julian Müller Stephanie Saxer Anna Titz Anwer Shehab Lena Reimann |
| author_sort | Konrad E Bloch |
| collection | DOAJ |
| description | Background Hypoxic pulmonary vasoconstriction leads to an increase in pulmonary artery pressure (PAP) and potentially right heart failure in healthy individuals and patients with respiratory diseases. Previous studies in patients with chronic obstructive pulmonary disease (COPD) exposed to hypobaric hypoxia have shown an increase in PAP, while traditional echocardiographic parameters revealed only minimal changes at high altitude. Speckle-tracking-derived analysis is potentially more sensitive to assess right ventricular (RV) function and we used this method to investigate the impact on RV function of patients with COPD ascending to high altitude and compared the results with the traditional echocardiographic parameters.Methods This post hoc analysis evaluates echocardiographic RV free wall strain (RVFWS) in patients with COPD GOLD grade 1–3 travelling from 760 m to 3100 m for a 2-day stay. An RVFWS over −20% was considered as an indicator of RV dysfunction.Results A total of 54 patients (57% men, mean±SD age 58±9 years, forced expiratory volume in 1 s (FEV1 % predicted 77.3±22.5)) with echocardiographs of sufficient quality were included. The mean RVFWS worsened significantly from −26.0±4.9% at 760 m to −23.9±5.4% at 3100 m (p=0.02). The number of patients with relevant RV dysfunction based on RVFWS increased from 7.4% at 760 m to 25.9% at 3100 m (p=0.02), whereas the prevalence of RV dysfunction assessed by traditional indices remained unchanged.Conclusion Exposure to hypoxia led to RVFWS impairment in more than one quarter of patients with COPD. Strain analysis is a promising, non-invasive method for evaluating RV dysfunction, even in subclinical cases and might be prognostically relevant in patients with lung diseases.Trial registration numbers NCT02450968 and NCT03173508. |
| format | Article |
| id | doaj-art-86728b6d454a430890bfbad69d9218bc |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-86728b6d454a430890bfbad69d9218bc2025-01-09T21:45:10ZengBMJ Publishing GroupOpen Heart2053-36242025-01-0112110.1136/openhrt-2024-002837Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trialsKonrad E Bloch0Mona Lichtblau1Silvia Ulrich2Felix C Tanner3Talant Sooronbaev4Maamed Mademilov5Michael Furian6Helga Preiss7Laura Mayer8Simon Rafael Schneider9Julian Müller10Stephanie Saxer11Anna Titz12Anwer Shehab13Lena Reimann143 Center of Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland8 Department of Pulmonology, University Hospital Zurich, Zurich, SwitzerlandRespiratory Medicine, University Hospital Zurich, Zurich, Switzerland1 Department of Cardiology, University Heart Center Zurich, Zurich, SwitzerlandDepartment of Pulmonology, National Centre of Cardiology and Internal Medicine named after academician Mirsaid Mirrakhimov, Bishkek, KyrgyzstanRespiratory medicine, National Center for Cardiology and Therapy named after academician Mirsaid Mirrakhimov under the Ministry of Health of the Kyrgyz Republic, Bishkek, KyrgyzstanSleep Disorders Center, Department of Respiratory Medicine, University Hospital of Zurich, Zurich, SwitzerlandRespiratory Medicine, University Hospital Zurich, Zurich, SwitzerlandRespiratory Medicine, University Hospital Zurich, Zurich, SwitzerlandUniversity Hospital Zurich, Zurich, Zurich, SwitzerlandUniversity Hospital Zurich, Zurich, Zurich, SwitzerlandUniversity Hospital Zurich, Zurich, Zurich, SwitzerlandUniversity Hospital Zurich, Zurich, Zurich, SwitzerlandClinic for Cardiology, University of Zurich, Zurich, SwitzerlandUniversity Hospital Zurich, Zurich, Zurich, SwitzerlandBackground Hypoxic pulmonary vasoconstriction leads to an increase in pulmonary artery pressure (PAP) and potentially right heart failure in healthy individuals and patients with respiratory diseases. Previous studies in patients with chronic obstructive pulmonary disease (COPD) exposed to hypobaric hypoxia have shown an increase in PAP, while traditional echocardiographic parameters revealed only minimal changes at high altitude. Speckle-tracking-derived analysis is potentially more sensitive to assess right ventricular (RV) function and we used this method to investigate the impact on RV function of patients with COPD ascending to high altitude and compared the results with the traditional echocardiographic parameters.Methods This post hoc analysis evaluates echocardiographic RV free wall strain (RVFWS) in patients with COPD GOLD grade 1–3 travelling from 760 m to 3100 m for a 2-day stay. An RVFWS over −20% was considered as an indicator of RV dysfunction.Results A total of 54 patients (57% men, mean±SD age 58±9 years, forced expiratory volume in 1 s (FEV1 % predicted 77.3±22.5)) with echocardiographs of sufficient quality were included. The mean RVFWS worsened significantly from −26.0±4.9% at 760 m to −23.9±5.4% at 3100 m (p=0.02). The number of patients with relevant RV dysfunction based on RVFWS increased from 7.4% at 760 m to 25.9% at 3100 m (p=0.02), whereas the prevalence of RV dysfunction assessed by traditional indices remained unchanged.Conclusion Exposure to hypoxia led to RVFWS impairment in more than one quarter of patients with COPD. Strain analysis is a promising, non-invasive method for evaluating RV dysfunction, even in subclinical cases and might be prognostically relevant in patients with lung diseases.Trial registration numbers NCT02450968 and NCT03173508.https://openheart.bmj.com/content/12/1/e002837.full |
| spellingShingle | Konrad E Bloch Mona Lichtblau Silvia Ulrich Felix C Tanner Talant Sooronbaev Maamed Mademilov Michael Furian Helga Preiss Laura Mayer Simon Rafael Schneider Julian Müller Stephanie Saxer Anna Titz Anwer Shehab Lena Reimann Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trials Open Heart |
| title | Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trials |
| title_full | Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trials |
| title_fullStr | Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trials |
| title_full_unstemmed | Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trials |
| title_short | Right ventricular strain impairment due to hypoxia in patients with COPD: a post hoc analysis of two randomised controlled trials |
| title_sort | right ventricular strain impairment due to hypoxia in patients with copd a post hoc analysis of two randomised controlled trials |
| url | https://openheart.bmj.com/content/12/1/e002837.full |
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