Traditional and Advanced Echocardiographic Evaluation in Chronic Obstructive Pulmonary Disease: The Forgotten Relation

Abstract

Chronic obstructive pulmonary disease (COPD) is a significant preventable and treatable clinical disorder defined by a persistent, typically progressive airflow obstruction. This disease has a significant negative impact on mortality and morbidity worldwide. However, the complex interaction between the heart and lungs is usually underestimated, necessitating more attention to improve clinical outcomes and prognosis. Indeed, COPD significantly impacts ventricular function, right and left chamber architecture, tricuspid valve functionality, and pulmonary blood vessels. Accordingly, more emphasis should be paid to their diagnosis since cardiac alterations may occur very early before COPD progresses and generate pulmonary hypertension (PH). Echocardiography enables a quick, noninvasive, portable, and accurate assessment of such changes. Indeed, recent advancements in imaging technology have improved the characterization of the heart chambers and made it possible to investigate the association between a few cardiac function indexes and clinical and functional aspects of COPD. This review aims to describe the intricate relation between COPD and heart changes and provide basic and advanced echocardiographic methods to detect early right ventricular and left ventricular morphologic alterations and early systolic and diastolic dysfunction. In addition, it is crucial to comprehend the clinical and prognostic significance of functional tricuspid regurgitation in COPD and PH and the currently available transcatheter therapeutic approaches for its treatment. Moreover, it is also essential to assess noninvasively PH and pulmonary resistance in patients with COPD by applying new echocardiographic parameters. In conclusion, echocardiography should be used more frequently in assessing patients with COPD because it may aid in discovering previously unrecognized heart abnormalities and selecting the most appropriate treatment to improve the patient's symptoms, quality of life, and survival. Chronic obstructive pulmonary disease (COPD) is a significant preventable and treatable clinical disorder defined by a persistent, typically progressive airflow obstruction. This disease has a significant negative impact on mortality and morbidity worldwide. However, the complex interaction between the heart and lungs is usually underestimated, necessitating more attention to improve clinical outcomes and prognosis. Indeed, COPD significantly impacts ventricular function, right and left chamber architecture, tricuspid valve functionality, and pulmonary blood vessels. Accordingly, more emphasis should be paid to their diagnosis since cardiac alterations may occur very early before COPD progresses and generate pulmonary hypertension (PH). Echocardiography enables a quick, noninvasive, portable, and accurate assessment of such changes. Indeed, recent advancements in imaging technology have improved the characterization of the heart chambers and made it possible to investigate the association between a few cardiac function indexes and clinical and functional aspects of COPD. This review aims to describe the intricate relation between COPD and heart changes and provide basic and advanced echocardiographic methods to detect early right ventricular and left ventricular morphologic alterations and early systolic and diastolic dysfunction. In addition, it is crucial to comprehend the clinical and prognostic significance of functional tricuspid regurgitation in COPD and PH and the currently available transcatheter therapeutic approaches for its treatment. Moreover, it is also essential to assess noninvasively PH and pulmonary resistance in patients with COPD by applying new echocardiographic parameters. In conclusion, echocardiography should be used more frequently in assessing patients with COPD because it may aid in discovering previously unrecognized heart abnormalities and selecting the most appropriate treatment to improve the patient's symptoms, quality of life, and survival. Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by abnormalities of the airways (bronchitis or bronchiolitis) and/or alveoli (emphysema) that results in chronic, progressive airflow obstruction associated with an enhanced chronic inflammatory response in the airways.1Agustí A Celli BR Criner GJ Halpin D Anzueto A Barnes P Bourbeau J Han MK Martinez FJ Montes de Oca M Mortimer K Papi A Pavord I Roche N Salvi S Sin DD Singh D Stockley R López Varela MV Wedzicha JA Vogelmeier CF Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary.Eur Respir J. 2023; 612300239Crossref Scopus (179) Google Scholar COPD has different clinical and radiologic phenotypes that represent a significant public health problem due to increased morbidity and mortality.1Agustí A Celli BR Criner GJ Halpin D Anzueto A Barnes P Bourbeau J Han MK Martinez FJ Montes de Oca M Mortimer K Papi A Pavord I Roche N Salvi S Sin DD Singh D Stockley R López Varela MV Wedzicha JA Vogelmeier CF Global Initiative for Chronic Obstructive Lung Disease 2023 report: GOLD executive summary.Eur Respir J. 2023; 612300239Crossref Scopus (179) Google Scholar, 2Segreti A Stirpe E Rogliani P Cazzola M Defining phenotypes in COPD: an aid to personalized healthcare.Mol Diagn Ther. 2014; 18: 381-388Crossref PubMed Scopus (47) Google Scholar, 3Antonelli Incalzi R Canonica GW Scichilone N Rizzoli S Simoni L Blasi F STORICO Study GroupThe COPD multi-dimensional phenotype: a new classification from the STORICO Italian observational study.PLoS One. 2019; 14e0221889Crossref PubMed Scopus (6) Google Scholar It is usually associated with many co-morbidities that may cause a decline in functional ability and quality of life and influence a patient's prognosis.4Barnes PJ Celli BR Systemic manifestations and comorbidities of COPD.Eur Respir J. 2009; 33: 1165-1185Crossref PubMed Scopus (1250) Google Scholar,5Cavaillès A Brinchault-Rabin G Dixmier A Goupil F Gut-Gobert C Marchand-Adam S Meurice JC Morel H Person-Tacnet C Leroyer C Diot P Comorbidities of COPD.Eur Respir Rev. 2013; 22: 454-475Crossref PubMed Scopus (329) Google Scholar However, the most significant co-morbidities that strongly affect the prognosis of patients with COPD remain cardiovascular (CV) problems.6Soriano JB Visick GT Muellerova H Payvandi N Hansell AL Patterns of comorbidities in newly diagnosed COPD and asthma in primary care.Chest. 2005; 128: 2099-2107Abstract Full Text Full Text PDF PubMed Scopus (472) Google Scholar Indeed, systolic or diastolic heart failure (HF) affects 20% to 70% of patients with COPD, and it is a significant and independent predictor of global mortality among them.7Bhatt SP Dransfield Chronic obstructive pulmonary disease and cardiovascular 2013; Full Text Full Text PDF PubMed Scopus Google Scholar the of disease in patients with COPD is increased by the relation between airflow and A I failure and chronic obstructive pulmonary a PubMed Scopus Google Scholar the significance of cardiac abnormalities is crucial to the morbidity associated with JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar and a it is essential to comprehend and the appropriate in patients with and COPD may to the of the of and JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar Echocardiography is a quick, noninvasive, and accurate to assess heart changes and In to its echocardiography is for prognosis the the of and is used a for to be S P D M in chronic obstructive pulmonary disease and of right ventricular with disease J Google of pulmonary hypertension in chronic obstructive pulmonary Google Scholar a of cardiac changes in patients with COPD and advanced echocardiographic is disease has a and mortality in with COPD, and mortality is a crucial for the among patients with J between COPD and cardiovascular Google Scholar cardiac or echocardiographic abnormalities very in patients with COPD their left and cardiac K C J M J E J C JA Study abnormalities in patients with COPD their Respir J. 2013; PubMed Scopus Google Scholar echocardiography should be patients with COPD due to the and prognostic of cardiac K C J M J E J C JA Study abnormalities in patients with COPD their Respir J. 2013; PubMed Scopus Google GW failure and chronic obstructive pulmonary and J 2009; PubMed Scopus Google Scholar pulmonary hypertension right ventricular disease and on the disease among patients with JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar S P D M in chronic obstructive pulmonary disease and of right ventricular with disease J Google Scholar that in of patients with COPD, the most echocardiographic in PH in of in right in systolic in of the left in and diastolic of in of S P D M in chronic obstructive pulmonary disease and of right ventricular with disease J Google Scholar In addition, patients with COPD more to from a an or JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar an mortality of to in patients with COPD, has S C failure and chronic obstructive pulmonary the and health J. 2013; PubMed Scopus Google Scholar that between and of patients with from COPD. the of has increased in recent S C failure and chronic obstructive pulmonary the and health J. 2013; PubMed Scopus Google J H Chronic obstructive pulmonary disease and heart PubMed Scopus Google Scholar and of significantly by COPD, and mortality in patients with with in COPD. In addition, pulmonary cause heart in to of the J H Chronic obstructive pulmonary disease and heart PubMed Scopus Google Scholar M E J C N A M C R L and prognosis of and heart failure patients with chronic obstructive pulmonary disease in the of J PubMed Scopus Google Scholar that the of chronic to have a negative prognostic also that COPD to 20% to in and in patients with chronic M E J C N A M C R L and prognosis of and heart failure patients with chronic obstructive pulmonary disease in the of J PubMed Scopus Google Scholar of the between have and to by COPD heart and the M H M M L S and therapeutic in patients with heart failure and chronic obstructive pulmonary 2019; PubMed Scopus Google Scholar associated that to cardiac changes is most have on patients with the of the disease is a in the of of heart in chronic obstructive pulmonary disease and its with the of PubMed Scopus Google Scholar and intricate of PH results from pulmonary due to and chronic and of and of BR of pulmonary hypertension in chronic obstructive pulmonary a Lung Full Text Full Text PDF PubMed Scopus Google N A R F N of pulmonary basic Respir J. PubMed Scopus Google Scholar PH an in and an in ventricular to of heart in chronic obstructive pulmonary disease and its with the of PubMed Scopus Google Scholar and inflammatory in patients with COPD is to and in a of failure characterized by and an to to the of heart in chronic obstructive pulmonary disease and its with the of PubMed Scopus Google Scholar is the used to describe and/or on by by chronic and function However, the be 2013; PubMed Google Scholar It is that in COPD results from chronic pulmonary resistance and hypertension on by the of the and the of the S K in COPD: pulmonary hypertension and pulmonary Respir Rev. 2014; PubMed Scopus Google Scholar of the new of has a pulmonary it is that be S K in COPD: pulmonary hypertension and pulmonary Respir Rev. 2014; PubMed Scopus Google Scholar with COPD frequently due to pulmonary hypertension and is the patient's prognosis is Moreover, the of is the of COPD of heart in chronic obstructive pulmonary disease and its with the of PubMed Scopus Google Scholar early of and PH may aid in patients with and their A on the of right ventricular in with the of Lung in chronic obstructive pulmonary disease J Google Scholar with COPD more and have a of Indeed, the significance of in and in patients with DD patients with chronic obstructive pulmonary disease increased of cardiovascular of in chronic obstructive pulmonary PubMed Scopus Google Scholar the and of and of COPD, cardiac frequently in patients with I R A J S I M of in patients with chronic obstructive pulmonary PubMed Scopus Google Scholar In addition, the for may be the for the disease However, the echocardiographic may the of in I R A J S I M of in patients with chronic obstructive pulmonary PubMed Scopus Google Scholar have that the cause of the increased of disease is it may be to such chronic and between the respiratory and E C A R J M of pulmonary in chronic obstructive pulmonary PubMed Scopus Google Scholar the between COPD and a crucial It is essential to that and of in and global on in of on Scholar Indeed, in patients COPD and is a GW failure and chronic obstructive pulmonary and J 2009; PubMed Scopus Google Scholar However, in patients with COPD with or of heart cardiac is that COPD may provide an independent for the of heart K C J M J E J C JA Study abnormalities in patients with COPD their Respir J. 2013; PubMed Scopus Google R JA E airflow and left ventricular J PubMed Scopus Google H G A M H cardiac chamber and associated heart in COPD: of Full Text Full Text PDF PubMed Scopus Google Scholar association between the heart and the lungs in is by the of such blood a of and in patients with P J M E J E S in chronic obstructive pulmonary results of the PubMed Scopus Google Scholar such and functional a in in the and chronic and of the and of and of K J J Chronic obstructive pulmonary disease and left PubMed Google Scholar Moreover, increased and may also pulmonary by or Chronic an essential in the of PH in COPD by of the JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar on by the of the to the of PH in patients with COPD by S Chronic obstructive pulmonary disease and the early of a in treatment with pulmonary 2019; PubMed Scopus Google Scholar Moreover, and associated with JA P J J S R in pulmonary of patients with chronic obstructive pulmonary J Respir PubMed Scopus Google Scholar with of and has the most morphologic JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar However, patients with COPD and that the pulmonary changes of the on by the of the E A Respir 2009; PubMed Scopus Google Scholar Indeed, due to is a to PH and JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar It is to that is a that to the of ventricular in COPD with in the of diastolic is to ventricular is an that JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google Scholar a of of and with COPD chronic to the the of and of the J J R association between COPD and heart failure a J 2013; PubMed Scopus Google Scholar in and and abnormalities to A I failure and chronic obstructive pulmonary a PubMed Scopus Google Scholar patients with COPD frequently have of their and pulmonary by the in of and JA S Criner GJ P disease in chronic obstructive pulmonary PubMed Scopus Google L R I J J M JA between and pulmonary in J PubMed Scopus Google Scholar the the between COPD and heart changes is its significance in the early of abnormalities is and to be the of clinical such and cardiac in accurate of cardiac abnormalities cardiac imaging is Echocardiography is a and to heart alterations and in patients with COPD. in the of be significantly by echocardiography and also have prognostic A E C C F E L S A G N R echocardiography and imaging in chronic pulmonary in of right ventricular PubMed Scopus Google Scholar However, by in of patients with COPD and frequently affect that echocardiography be in J H Chronic obstructive pulmonary disease and heart PubMed Scopus Google Scholar In the of of the pulmonary or of the However, the in is also to and M of the right an PubMed Scopus Google Scholar of the most imaging is cardiac by the of the such complex and a few that influence the of S C R S A F D J right heart in heart failure with from cardiac imaging and J 18: PubMed Scopus Google Scholar and with it the in S C R S A F D J right heart in heart failure with from cardiac imaging and J 18: PubMed Scopus Google Scholar Moreover, of valve and of blood J J R association between COPD and heart failure a J 2013; PubMed Scopus Google S C R S A F D J right heart in heart failure with from cardiac imaging and J 18: PubMed Scopus Google Scholar is used echocardiography has because of its and it is crucial to basic and advanced echocardiographic of cardiac abnormalities in patients with COPD. between echocardiographic and COPD is in by PH for patients with COPD to of the with or is the and the and the in the In is to a cardiac by a and systolic to recent K JA J in chronic obstructive pulmonary disease and the COPD 2014; PubMed Scopus Google M JA H A and right ventricular and the Study of and Study of 2013; Full Text Full Text PDF PubMed Scopus Google Scholar In and may cause diastolic S A A ventricular diastolic and the of in pulmonary hypertension Full Text Full Text PDF PubMed Scopus Google Scholar the of changes in patients with COPD, associated with be in for the the of the is characterized by an in and A N between the right and its in pulmonary PubMed Scopus Google Scholar the a the it is to the to an A N between the right and its in pulmonary PubMed Scopus Google Scholar influence of on function in In addition, the of the to ventricular systolic results in the of and a failure in and a A N between the right and its in pulmonary PubMed Scopus Google Scholar, A A in pulmonary in is to right ventricular and left ventricular PubMed Scopus Google Scholar, A J AL D N H of for right heart failure in pulmonary Respir J. PubMed Scopus Google Scholar However, it is that is an that the of PH M M P M E in chronic obstructive pulmonary disease of the PubMed Google Scholar In COPD, an assessment is crucial since its is to and a A J AL D N H of for right heart failure in pulmonary Respir J. PubMed Scopus Google N P of echocardiographic of right ventricular function in prognosis in chronic pulmonary Full Text Full Text PDF PubMed Scopus Google Scholar K C J M J E J C JA Study abnormalities in patients with COPD their Respir J. 2013; PubMed Scopus Google Scholar that the most echocardiographic of the patients with COPD K C J M J E J C JA Study abnormalities in patients with COPD their Respir J. 2013; PubMed Scopus Google Scholar to the is an that is is by a of the and the and a more significant N P of echocardiographic of right ventricular function in prognosis in chronic pulmonary Full Text Full Text PDF PubMed Scopus Google J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar However, recent that the or for the and and the to tricuspid D F E recent in and J PubMed Scopus Google Scholar it that patients with COPD more frequently a with a I D J S K of right ventricular in PubMed Scopus Google Scholar In COPD, is to prognostic such functional ability and more and echocardiography may patients more approaches to COPD F G S M F R M A R of right diastolic with pulmonary function, and in patients with chronic obstructive pulmonary a Full Text Full Text PDF PubMed Scopus Google Scholar to a recent is an early of the response to in patients with COPD with A S changes of cardiac and function in COPD patients with 2005; Full Text Full Text PDF PubMed Scopus Google Scholar in COPD is typically to in the in early COPD I J S K ventricular and in chronic obstructive pulmonary disease pulmonary 2013; PubMed Scopus Google Scholar be in from the However, it be from the left and may ventricular J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar I J S K ventricular and in chronic obstructive pulmonary disease pulmonary 2013; PubMed Scopus Google Scholar a of the among patients with COPD However, in the of chronic the is the of the that is most it is the to in the of the ventricular and failure in chronic PubMed Scopus Google Scholar left is used to and the left is used for the ventricular and failure in chronic PubMed Scopus Google Scholar However, for available to ventricular and failure in chronic PubMed Scopus Google Scholar chamber that should be and be in COPD is the of function, and to a in patients with R L R heart changes associated with in One. PubMed Scopus Google Scholar or or and be the the of the J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar However, the is a more accurate of diastolic more to assess J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar This cardiac function has in relation to pulmonary However, has a in clinical such systolic G P F M E S M cardiac in a from diagnosis to PubMed Scopus Google Scholar assessing patients with COPD, the echocardiographic the assessment of and and function echocardiography G P F M E S M cardiac in a from diagnosis to PubMed Scopus Google Scholar echocardiographic to assess systolic and diastolic is a prognostic in patients with COPD because with ability and a N P of echocardiographic of right ventricular function in prognosis in chronic pulmonary Full Text Full Text PDF PubMed Scopus Google Scholar In addition, patients with airflow obstruction may have diagnosed by R PH left and right ventricular in patients with Full Text Full Text PDF PubMed Scopus Google Scholar is also a association between the of airflow and and the of COPD S P D M in chronic obstructive pulmonary disease and of right ventricular with disease J Google Scholar In S and tricuspid systolic the with the most in of their is the and the systolic J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar to the of to to and J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar the of the systolic the tricuspid valve from an and or to systolic dysfunction. It is that and on of the function of and the that represent function J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar be used in that may in dysfunction. the of the or the of the be used to the the of in in the for J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar to R C L R P A by echocardiography for pulmonary hypertension due to chronic a J PubMed Scopus (6) Google Scholar a echocardiographic patients with COPD and PH have systolic and have to in patients with COPD and G D M R and clinical classification of pulmonary Respir J. 2019; Scopus Google Scholar a the of systolic in patients with COPD the of cardiac that the of and of the of the approaches for echocardiographic of function have frequently function be early to the of imaging and of and advanced echocardiographic for assessment in I J S K ventricular and in chronic obstructive pulmonary disease pulmonary 2013; PubMed Scopus Google Scholar that patients with COPD failure before echocardiographic and global with or Singh S M of right ventricular function and its in the prognosis of chronic obstructive pulmonary PubMed Scopus Google Scholar in a recent that of patients with COPD dysfunction. in the of and with Singh S M of right ventricular function and its in the prognosis of chronic obstructive pulmonary PubMed Scopus Google Scholar function be more defined and that and is the of cardiac In is the in and is and by the of J L K for the echocardiographic assessment of the right heart in a from the of Echocardiography by the of a of the of and the of Full Text Full Text PDF PubMed Scopus Google Scholar global is by the to of systolic This is by heart and is usually defined J A L E P D L for cardiac chamber by echocardiography in an from the of Echocardiography and the of Full Text Full Text PDF PubMed Scopus Google Scholar However, be for different in a recent early of function is to in the with a of M C S of a or a for clinical 2019; PubMed Scopus Google Scholar It has also that the airflow and for patients with is a in an of E F E A S a of right in patients with chronic obstructive pulmonary a 2014; PubMed Scopus Google Scholar Moreover, a recent that more significant in patients with PH and among with PH and diastolic C R L D S G D of echocardiography in the diagnosis of pulmonary One. PubMed Scopus Google Scholar the between its clinical an the significance of of PH and between PH C R L D S G D of echocardiography in the diagnosis of pulmonary One. PubMed Scopus Google Scholar due to the ventricular and enables an and of J A L E P D L for cardiac chamber by echocardiography in an from the of Echocardiography and the of Full Text Full Text PDF PubMed Scopus Google Scholar should be different of for for to that the is in and A H J M L L M echocardiography assessment of right ventricular and and clinical PubMed Scopus Google Scholar However, available for the the function the the and the to and and A H J M L L M echocardiography assessment of right ventricular and and clinical PubMed Scopus Google G C F L A M S P G M of right ventricular function and to echocardiographic J 2019; PubMed Scopus Google Scholar In patients with the and to be an independent predictor of A E C C F E L S A G N R echocardiography and imaging in chronic pulmonary in of right ventricular PubMed Scopus Google Scholar A E C C F E L S A G N R echocardiography and imaging in chronic pulmonary in of right ventricular PubMed Scopus Google Scholar also for global and and of patients with PH and of the of A E C C F E L S A G N R echocardiography and imaging in chronic pulmonary in of right ventricular PubMed Scopus Google Scholar a clinical for a pulmonary enables clinical of the of in function and the I M M ventricular functional pulmonary in patients with COPD by Google Scholar is an of the diastolic and systolic global in the is to methods such assessment noninvasively A M A SP G C S R F F and tricuspid valve disease in 2023; PubMed Scopus Google Scholar of indexes that by the global global global and global is a and pulmonary to A M A SP G C S R F F and tricuspid valve disease in 2023; PubMed Scopus Google Scholar A recent that and and may be of systolic J K M among right ventricular and the of systolic and diastolic PubMed Scopus Google Scholar In patients with a recent that and strongly with Moreover, pulmonary resistance with global and global C I J F E A G D N ventricular characterization in patients with pulmonary hypertension and relation to and J Full Text Full Text PDF PubMed Scopus Google Scholar with echocardiographic indexes of function, of and to C I J F E A G D N ventricular characterization in patients with

Topics & Concepts