Am. J. Respir. Crit. Care Med., Volume 162, Number 2, August 2000, 670-675

Left Atrial and Ventricular Filling in Chronic Obstructive Pulmonary Disease
An Echocardiographic and Doppler Study

ALAIN BOUSSUGES, CHRISTOPHE PINET, FLORENCE MOLENAT, HENRI BURNET, PIERRE AMBROSI, MONIQUE BADIER, JEAN-MARIE SAINTY, and JEAN OREHEK

Service de Réanimation Médicale et Hyperbarie, CHU Salvator, Marseille, France; Département des Maladies Respiratoires, CHU Sainte Marguerite, Marseille, France; Service de Réanimation Polyvalente, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France; CNRS, Laboratoire de Neurobiologie et Mouvement, Marseille, France; and Service de Cardiologie B, CHU Timone, Marseille, France

Abnormal left ventricular (LV) diastolic function has frequently been reported in patients with chronic obstructive pulmonary disease (COPD). In the present work, diastolic function was studied by a combined analysis of pulmonary venous and mitral blood flow velocities in 34 patients with COPD clinically stable and without history of heart disease, and 20 control subjects. We confirmed the increased contribution of the atrial contraction to the LV filling in COPD patients in comparison with control subjects; furthermore, a decreased left atrial (LA) filling during the ventricular systole was observed. Changes in LV filling were not the consequence of a systolic dysfunction, because LV systolic function was normal. Doppler indices indicated that LA pressure was below 15 cm H₂O in all the patients with COPD and control subjects. Several factors can be put forward to explain these changes; the first one is tachycardia. In addition to hypoxemia and medications, echocardiography suggested that a decreased LV preload participated in increased heart rate. Analysis of Doppler transmitral and pulmonary venous flows demonstrated the role of the ventricular interdependence because a correlation existed between LA and LV filling pattern and right ventricle pressure and diameter.

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