Advertisement

Lung

, Volume 195, Issue 1, pp 9–17 | Cite as

State of the Art Review of the Right Ventricle in COPD Patients: It is Time to Look Closer

  • Daniela Graner Schuwartz Tannus-SilvaEmail author
  • Marcelo Fouad Rabahi
Article

Abstract

Since the first description of pulmonary circulation in the 16th century, the knowledge of the complex interaction between the heart and lungs has greatly improved. Hypoxemia plays a classical role in the development of complications such as pulmonary hypertension and right ventricle (RV) dysfunction in patients presenting with chronic obstructive pulmonary disease (COPD). However, more recent results have revealed the presence of RV vascular structural and functional changes even in patients with mild COPD, without hypoxemia or pulmonary hypertension at rest. Compared to the left ventricle, the anatomy of the RV is unique and complex, which makes its assessment more difficult during routine exams. Therefore, it is common that very little attention is paid to its study. In this article, the physiological aspects of pulmonary circulation and the RV, as well as their impairment in COPD patients, are presented. In addition, important aspects of the recommendations for RV assessment using echocardiography are approached and studies that used other complementary exams to evaluate RV structure and function are revisited. Finally, the findings of studies that assessed the impact of RV dysfunction in the prognosis of patients with COPD are described.

Keywords

COPD Right ventricle dysfunction Right ventricle assessment Echocardiography 

Notes

Acknowledgements

The authors thank Dr. João Batista Masson Silva for providing the echocardiographic images and Fundação de Amparo à Pesquisa do Estado de Goiás (FAPEG) for the financial support (Process Number 201210267001130).

Compliance with Ethical Standards

Conflict of interest

None.

References

  1. 1.
    Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R (2013) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 187:347–365. doi: 10.1164/rccm.201204-0596PP CrossRefPubMedGoogle Scholar
  2. 2.
    García-Olmos L, Alberquilla Á, Ayala V, García-Sagredo P, Morales L, Carmona M, de Tena-Dávila MJ, Pascual M, Muñoz A, Salvador CH (2013) Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study. BMC Fam Pract 14:11. doi: 10.1186/1471-2296-14-11 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Barnes PJ, Celli BR (2009) Systemic manifestations and comorbidities of COPD. Eur Respir J 33:1165–1185. doi: 10.1183/09031936.00128008 CrossRefPubMedGoogle Scholar
  4. 4.
    Wilson LG (1962) The problem of the discovery of the pulmonary circulation. J Hist Med Allied Sci 17:229–244. doi: 10.1093/jhmas/XVII.2.229 CrossRefPubMedGoogle Scholar
  5. 5.
    Bedrikow R, Golin V (2000) A história da descoberta da circulação pulmonar. J Pneumol 26:XI. doi: 10.1590/S0102-35862000000100012 CrossRefGoogle Scholar
  6. 6.
    Greyson CR (2010) The right ventricle and pulmonary circulation: basic concepts. Rev Esp Cardiol 63:81–95. doi: 10.1016/S1885-5857(10)70012-8 CrossRefPubMedGoogle Scholar
  7. 7.
    Carvalho CRR (2006) Fisiopatologia respiratória. Editora Atheneu, São PauloGoogle Scholar
  8. 8.
    Wright JL, Petty T, Thurlbeck WM (1992) Analysis of the structure of the muscular pulmonary arteries in patients with pulmonary hypertension and COPD: National Institutes of Health nocturnal oxygen therapy trial. Lung 170:109–124. doi: 10.1007/BF00175982 CrossRefPubMedGoogle Scholar
  9. 9.
    Arias-Stella J, Saldana M (1963) The terminal portion of the pulmonary arterial tree in people native to high altitudes. Circulation 28:915–925. doi: 10.1161/01.CIR.28.5.915 CrossRefPubMedGoogle Scholar
  10. 10.
    Santos S, Peinado VI, Ramirez J, Melgosa T, Roca J, Rodriguez-Roisin R, Barbera JA (2002) Characterization of pulmonary vascular remodelling in smokers and patients with mild COPD. Eur Respir J 19:632–638. doi: 10.1183/09031936.02.00245902 CrossRefPubMedGoogle Scholar
  11. 11.
    Barberà JA, Riverola A, Roca J, Ramirez J, Wagner PD, Ros D, Wiggs BR, Rodriguez-Roisin R (1994) Pulmonary vascular abnormalities and ventilation-perfusion relationships in mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med 149:423–429. doi: 10.1164/ajrccm.149.2.8306040 CrossRefPubMedGoogle Scholar
  12. 12.
    Magee F, Wright JL, Wiggs BR, Pare PD, Hogg JC (1988) Pulmonary vascular structure and function in chronic obstructive pulmonary disease. Thorax 43:183–189. doi: 10.1136/thx.43.3.183 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Barberà J, Blanco I (2009) Pulmonary hypertension in patients with chronic obstructive pulmonary disease: advances in pathophysiology and management. Drugs 69:1153–1171. doi: 10.2165/00003495-200969090-00002 CrossRefPubMedGoogle Scholar
  14. 14.
    Haddad F, Hunt SA, Rosenthal DN, Murphy DJ (2008) Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 117:1436–1448. doi: 10.1161/CIRCULATIONAHA.107.653576 CrossRefPubMedGoogle Scholar
  15. 15.
    Santamore W, Dell’Italia L (1998) Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Prog Cardiovasc Dis 40:289–308. doi: 10.1016/S0033-0620(98)80049-2 CrossRefPubMedGoogle Scholar
  16. 16.
    Dell’Italia LJ (1991) The right ventricle: anatomy, physiology, and clinical importance. Curr Probl Cardiol 16:653–720. doi: 10.1016/0146-2806(91)90009-Y PubMedGoogle Scholar
  17. 17.
    Dell’Italia LJ (2012) Anatomy and physiology of the right ventricle. Cardiol Clin 30:167–187. doi: 10.1016/j.ccl.2012.03.009 CrossRefPubMedGoogle Scholar
  18. 18.
    Jiang L (1994) Principles and practice of echocardiography. In: Ae W (ed) Principle and practice of echocardiography. Lippincott Williams & Wilkins, Baltimore, pp 901–921Google Scholar
  19. 19.
    MacNee W (1994) Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 150:833–852. doi: 10.1164/ajrccm.150.3.8087359 CrossRefPubMedGoogle Scholar
  20. 20.
    WHO (1963) Chronic cor pulmonale, report of an expert committee. Circulation 27:594–615. doi: 10.1161/01.CIR.27.4.594 CrossRefGoogle Scholar
  21. 21.
    Niederman M, Matthay R (1986) Cardiovascular function in secondary pulmonary hypertension. Heart Lung 15:341–351 PMID: 3522488 PubMedGoogle Scholar
  22. 22.
    Hilde JM, Skjørten I, Grøtta OJ, Hansteen V, Melsom MN, Hisdal J, Humerfelt S, Steine K (2013) Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol 62:1103–1111. doi: 10.1016/j.jacc.2013.04.091 CrossRefPubMedGoogle Scholar
  23. 23.
    Rubin LJ (2013) Cor pulmonale revisited. J Am Coll Cardiol 62:1112–1113. doi: 10.1016/j.jacc.2013.06.034 CrossRefPubMedGoogle Scholar
  24. 24.
    Himelman RB, Struve SN, Brown JK, Namnum P, Schiller NB (1988) Improved recognition of cor pulmonale in patients with severe chronic obstructive pulmonary disease. Am J Med 84:891–898. doi: 10.1016/0002-9343(88)90068-X CrossRefPubMedGoogle Scholar
  25. 25.
    Matthay R, Berger H (1981) Cardiovascular performance in chronic obstructive pulmonary diseases. Med Clin North Am 65:489–524CrossRefPubMedGoogle Scholar
  26. 26.
    Kent BD, Mitchell PD, McNicholas WT (2011) Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis 6:199–208. doi: 10.2147/COPD.S10611 PubMedPubMedCentralGoogle Scholar
  27. 27.
    Joppa P, Petrasova D, Stancak B, Tkacova R (2006) Systemic inflammation in patients with COPD and pulmonary hypertension. Chest 130:326–333. doi: 10.1378/chest.130.2.326 CrossRefPubMedGoogle Scholar
  28. 28.
    Nakamura A, Kasamatsu N, Hashizume I, Shirai T, Hanzawa S, Momiki S, Sasaki K, Kinoshita M, Okada O, Tatsumi K, Kuriyama T (2000) Effects of hemoglobin on pulmonary arterial pressure and pulmonary vascular resistance in patients with chronic emphysema. Respiration 67:502–506. doi: 10.1159/000067463 CrossRefPubMedGoogle Scholar
  29. 29.
    Matsuoka S, Washko GR, Yamashiro T, Estepar RS, Diaz A, Silverman EK, Hoffman E, Fessler HE, Criner GJ, Marchetti N, Scharf SM, Martinez FJ, Reilly JJ, Hatabu H (2010) Pulmonary hypertension and computed tomography measurement of small pulmonary vessels in severe emphysema. Am J Respir Crit Care Med 181:218–225. doi: 10.1164/rccm.200908-1189OC CrossRefPubMedGoogle Scholar
  30. 30.
    Kolb TM, Hassoun PM (2012) Right ventricular dysfunction in chronic lung disease. Cardiol Clin 30:243–256. doi: 10.1016/j.ccl.2012.03.005 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Shaw JG, Dent AG, Passmore LH, Burstow DJ, Bowman RV, Zimmerman PV, Fong KM, Yang IA (2012) Genetic influences on right ventricular systolic pressure (RVSP) in chronic obstructive pulmonary disease (COPD). BMC Pulmon Med 12:25. doi: 10.1186/1471-2466-12-25 CrossRefGoogle Scholar
  32. 32.
    Das M, Tapadar SR, Mahapatra ABS, Chowdhury SP, Basu S (2014) Assessment of RV function in patients of (COPD). J Clin Diagn Res 8:11–13. doi: 10.7860/JCDR/2014/6440.4090 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Vonk-Noordergraaf A, Marcus T, Holverda S, Roseboom B, Postmus PE (2005) Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest 127:1898–1903. doi: 10.1378/chest.127.6.1898 CrossRefGoogle Scholar
  34. 34.
    Sabit R, Bolton CE, Fraser AG, Edwards JM, Edwards PH, Ionescu AA, Cockcroft JR, Shale DJ (2010) Sub-clinical left and right ventricular dysfunction in patients with COPD. Respir Med 104:1171–1178. doi: 10.1016/j.rmed.2010.01.020 CrossRefPubMedGoogle Scholar
  35. 35.
    Oswald-Mammosser M, Apprill M, Bachez P, Ehrhart M, Weitzenblum E (1991) Pulmonary hemodynamics in chronic obstructive pulmonary disease of the emphysematous type. Respiration 58:304–310. doi: 10.1159/000195950 CrossRefPubMedGoogle Scholar
  36. 36.
    Fenster BE, Holm KE, Weinberger HD, Moreau KL, Meschede K, Crapo JD, Make BJ, Bowler R, Wamboldt FS, Hoth KF (2015) Right ventricular diastolic function and exercise capacity in COPD. Respir Med 109:1287–1292. doi: 10.1016/j.rmed.2015.09.003 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713. doi: 10.1016/j.echo.2010.05.010 CrossRefPubMedGoogle Scholar
  38. 38.
    Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV (2009) Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 11:130–139. doi: 10.1093/eurjhf/hfn013 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Arcasoy SM, Arcasoy SM, Christie JD, Ferrari VA, Sutton MSJ, Zisman DA, Blumenthal NP, Pochettino A, Kotloff RM (2003) Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 167:735–740. doi: 10.1164/rccm.200210-1130OC CrossRefPubMedGoogle Scholar
  40. 40.
    Mertens LL, Friedberg MK (2010) Imaging the right ventricle–current state of the art. Nat Rev Cardiol 7:551–563. doi: 10.1038/nrcardio.2010.118 CrossRefPubMedGoogle Scholar
  41. 41.
    Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, Seward JB (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9:838–847. doi: 10.1016/S0894-7317(96)90476-9 CrossRefPubMedGoogle Scholar
  42. 42.
    Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S (2011) Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. Chest 139:988–993. doi: 10.1378/chest.10-1269 CrossRefPubMedGoogle Scholar
  43. 43.
    McQuillan BM, Picard MH, Leavitt M, Weyman AE (2001) Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 104:2797–2802. doi: 10.1161/hc4801.100076 CrossRefPubMedGoogle Scholar
  44. 44.
    Badesch DB, Champion HC, Sanchez MAG, Hoeper MM, Loyd JE, Manes A, McGoon M, Naeije R, Olschewski H, Oudiz RJ, Torbicki A (2009) Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 54:S55–S66. doi: 10.1016/j.jacc.2009.04.011 CrossRefPubMedGoogle Scholar
  45. 45.
    Sharma B, Neilan TG, Kwong RY, Mandry D, Owens RL, McSharry D, Bakker JP, Malhotra A (2013) Evaluation of right ventricular remodeling using cardiac magnetic resonance imaging in co-existent chronic obstructive pulmonary disease and obstructive sleep apnea. COPD 10:4–10. doi: 10.3109/15412555.2012.719050 CrossRefPubMedGoogle Scholar
  46. 46.
    Rocha NN, Stelmach R, Cukier A, Parga JR, Avila LF, Caldas M, Buck P, Mady C (2004) Assessment of the ventricular function of patients with advanced chronic obstructive pulmonary disease by using magnetic resonance imaging. Arq Bras Cardiol 83(326–331):320–325. doi: 10.1590/S0066-782X2004001600007 Google Scholar
  47. 47.
    Gao Y, Du X, Qin W, Li K (2011) Assessment of the right ventricular function in patients with chronic obstructive pulmonary disease using MRI. Acta Radiol 52:711–715. doi: 10.1258/ar.2011.100449 CrossRefPubMedGoogle Scholar
  48. 48.
    Gao Y, Du X, Liang L, Cao L, Yang Q, Li K (2012) Evaluation of right ventricular function by 64-row CT in patients with chronic obstructive pulmonary disease and cor pulmonale. Eur J Radiol 81:345–353. doi: 10.1016/j.ejrad.2010.11.004 CrossRefPubMedGoogle Scholar
  49. 49.
    Tadic M (2015) Multimodality evaluation of the right ventricle: an updated review. Clin Cardiol 38:770–776. doi: 10.1002/clc.22443 CrossRefPubMedGoogle Scholar
  50. 50.
    Wolf JE, Fagret D, Godart J, Comet M, Paramelle B (1986) Measurement of right ventricular ejection fraction with krypton-81 m in chronic obstructive pulmonary disease. Bull Eur Physiopathol Respir 22:539–544 PMID: 3828544 PubMedGoogle Scholar
  51. 51.
    Burghuber OC, Bergmann H (1988) Right-ventricular contractility in chronic obstructive pulmonary disease: a combined radionuclide and hemodynamic study. Respiration 53:1–12. doi: 10.1159/000195389 CrossRefPubMedGoogle Scholar
  52. 52.
    Gargiulo P, Cuocolo A, Dellegrottaglie S, Prastaro M, Savarese G, Assante R, Zampella E, Paolillo S, Scala O, Ruggiero D, Marsico F, Filardi PP (2015) Nuclear assessment of right ventricle. Echocardiography 32:S69–S74. doi: 10.1111/echo.12180 CrossRefPubMedGoogle Scholar
  53. 53.
    Daniels L, Maisel A (2007) Natriuretic peptides. J Am Coll Cardiol 50:2357–2368. doi: 10.1016/j.jacc.2007.09.021 CrossRefPubMedGoogle Scholar
  54. 54.
    Leuchte HH, Baumgartner RA, Nounou ME, Vogeser M, Neurohr C, Trautnitz M, Behr J (2006) Brain natriuretic peptide is a prognostic parameter in chronic lung disease. Am J Respir Crit Care Med 173:744–750. doi: 10.1164/rccm.200510-1545OC CrossRefPubMedGoogle Scholar
  55. 55.
    Inoue Y, Kawayama T, Iwanaga T, Aizawa H (2009) High plasma brain natriuretic peptide levels in stable COPD without pulmonary hypertension or cor pulmonale. Int Med 48:503–512. doi: 10.2169/internalmedicine.48.1701 CrossRefGoogle Scholar
  56. 56.
    Seeger W, Adir Y, Barberà JA, Champion H, Coghlan JG, Cottin V, De Marco T, Galiè N, Ghio S, Gibbs S, Martinez FJ, Semigran MJ, Simonneau G, Wells AU, Vachiéry JL (2013) Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol 62:D109–D116. doi: 10.1016/j.jacc.2013.10.036 CrossRefPubMedGoogle Scholar
  57. 57.
    Foster TS, Miller JD, Marton JP, Caloyeras JP, Russell MW, Menzin J (2006) Assessment of the economic burden of COPD in the U.S.: a review and synthesis of the literature. COPD 3:211–218. doi: 10.1080/15412550601009396 CrossRefPubMedGoogle Scholar
  58. 58.
    Mannino DM, Thorn D, Swensen A, Holguin F (2008) Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 32:962–969. doi: 10.1183/09031936.00012408 CrossRefPubMedGoogle Scholar
  59. 59.
    Weintzenblum E, Hirth C, Ducolone A, Mirhom R, Rasaholinjanahaty J, Ehrhart M (1981) Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease. Thorax 36:752–758. doi: 10.1136/thx.36.10.752 CrossRefGoogle Scholar
  60. 60.
    Oswald-Mammosser M, Weintzenblum E, Quoix E, Moser G, Chaouat A, Charpentier C, Kessler R (1995) Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest 107:1193–1198. doi: 10.1378/chest.107.5.1193 CrossRefPubMedGoogle Scholar
  61. 61.
    Burgess MI, Mogulkoc N, Bright-Thomas RJ, Bishop P, Egan JJ, Ray SG (2002) Comparison of echocardiographic markers of right ventricular function in determining prognosis in chronic pulmonary disease. J Am Soc Echocardiogr 15:633–639. doi: 10.1067/mje.2002.118526 CrossRefPubMedGoogle Scholar
  62. 62.
    Cuttica MJ, Shah SJ, Rosenberg SR, Orr R, Beussink L, Dematte JE, Smith LJ, Kalhan R (2011) Right heart structural changes are independently associated with exercise capacity in non-severe COPD. PLoS One 6:e29069. doi: 10.1371/journal.pone.0029069 CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Tanaka Y, Hino M, Mizuno K, Gemma A (2013) Evalution of right ventricular function in patients with COPD. Respir Care 58:816–823PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Departamento de Clínica Médica, Faculdade de MedicinaUniversidade Federal de GoiásGoiâniaBrazil

Personalised recommendations