Citation: Fakharian A, Masouleh SK, Farhadi T () Relation between cor pulmonale status The exact prevalence of cor pulmonale in COPD is unknown but. between acidosis and hypercapnia with corpulmonale in patients with COPD. significantly negative correlation between RV thickness with FEV1/forced vital. One study of 38 patients with stable COPD, 20 of whom had clinical cor pulmonale, found significant correlation between brain natriuretic.
Cor pulmonale: MedlinePlus Medical Encyclopedia
This mechanism may assume a more important role in development of PH during exercise and in patients with severe emphysema who are not hypoxemic. Changes in RV SV must invariably alter left ventricular LV preload, because the two ventricles are serially linked through the pulmonary vasculature. More importantly, hyperinflation, particularly during exercise, has the effect of compressing the two ventricles into each other [ 5556 ].
During an acute exacerbation of COPD, the RV may actually fail, that is, end-diastolic pressure and volume rise and RVEF falls, resulting in peripheral edema and systemic congestion [ 5758 ].Difference Between COPD and Asthma
However, these changes may not be associated with a rise in PAP suggesting that other factors may be operating to reduce RV contractility [ 57 ]. Moreover, an acute exacerbation may be associated with peripheral edema in the absence of RV failure [ 58 ].
The pathogenesis of edema formation in COPD is complex.
Renal blood flow is reduced, the renin-angiotensin system is activated, renal dopamine output is reduced, and plasma ANP level is elevated leading to increase in proximal renal tubular sodium reabsorption [ 5960 ].
Sodium retention is enhanced by hypercapnia and ameliorated by long-term oxygen therapy in hypoxemic patients [ 61 ].
- Cor Pulmonale
- Pulmonary hypertension and chronic cor pulmonale in COPD
True right heart failure is characterized by raised jugular venous pressures, congestive hepatomegaly, and peripheral edema. Such patients are characterized by mild to moderate airway obstruction, a very low diffusing capacity, severe hypoxemia, and hypocapnia Table 2 [ 62 ]. Diagnosis of PH in COPD PH secondary to COPD should be suspected in patients with progressive dyspnea on exertion with stable airway obstruction or in patients with mild to moderate airway obstruction with a very low diffusing capacity, severe hypoxemia, and hypocapnia [ 662 ].
Clinical Features The clinical exam lacks sensitivity and specificity.
Pulmonary Hypertension Secondary to COPD
Percent emphysema was defined using Apollo software Vida Diagnostics, Coralville, IA as the percentage of total voxels within the lung field that fell below Hounsfield units In addition, the presence or absence of any emphysema and predominant emphysema subtype was assessed visually on all CT scans by an experienced thoracic radiologist 24 blinded to other clinical information. Magnetic Resonance Imaging The cardiac MRI protocol was that of the fifth examination of MESA modified to include assessment of the pulmonary vasculature 25and the protocol and methods for interpretation have been previously reported 26 RV image analysis was performed by two independent analysts who were unaware of other clinical information using QMASS software v4.
RV end-diastolic volume and RV end-systolic volume were calculated using Simpson's rule by summation of areas on each slice multiplied by the sum of slice thickness and image gap. RV mass was determined at end-diastole as the difference between end-diastolic epicardial and endocardial volumes multiplied by the specific gravity of the heart 1.
Our method of interpretation has been shown to have high intra-reader and inter-reader reproducibility Pulmonary microvascular perfusion was assessed on a coronal slice at the level of the trachea in the peripheral 2 cm of the lung, as previously described 29 See Supplemental Material for details of other pulmonary function measures, the CT and MRI protocols, and microvascular perfusion measures.
Medication use was assessed by medication inventory Height, weight and blood pressure were measured following standardized MESA protocols Oxygen saturation was measured with a pulse oximeter off oxygen, if used. Linear regression models included categories of COPD status and severity as independent variables and continuous RV parameters as dependent variables.
A test of trend across categories of COPD severity was performed; if positive, Holm's step-down procedure was performed. Linear regression models were also constructed for continuous independent variables, weighted according to cohort specific probabilities of selection and enrollment into the MESA-COPD study to account for sampling Robust standard errors were used.
Results are shown by quintiles of percent emphysema for descriptive purposes; statistical tests were based upon the continuous variable in the regression model.
The nonlinearity of these associations was tested in generalized additive models with the same weighting and robust standard errors. The fully adjusted models also included smoking status, pack-years, hypertension, and sleep apnea and milliamperes for percent emphysema. The full models were adjusted for the respective LV parameters to better understand if the associations were RV-specific.