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Echocardiography and N-terminal-pro-brain natriuretic peptide in assessment of left ventricular diastolic dysfunction in stable COPD in relation to disease severity


 Introduction: Left ventricular diastolic dysfunction (LVDD) is found to be frequent in COPD patients. Relationship between airflow obstruction and cardiovascular risk can be explained by inflammation which is considered one of systemic manifestations of COPD. Objective: To assess the LVDD in COPD patients in relation to disease severity using echocardiography, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitive C-reactive protein (hs-CRP). Patients and methods: This prospective study was carried out on 60 stable COPD patients who were recruited from outpatient chest clinics, Tanta University Hospitals. Diagnosis of COPD was made according to criteria of the Global Initiative for Chronic Obstructive Lung Disease. Patients were subjected to medical history and physical examination, chest X ray, pulmonary functions, ECG and echocardiography. Blood samples were withdrawn for assessment of NT-proBNP and hs-CRP. Results: Diastolic function of the heart was evaluated by echocardiography using: isovolumetric relaxation time (IVRT), deceleration time of early transmitral flow, ratio of the peak velocity of the early E wave/A wave which suggested that LVDD was recorded more in severe/very severe compared to mild/moderate COPD. Significant positive correlations were found between Nt-pro BNP and hs-CRP, IVRT, deceleration time of early transmitral flow and E/A wave ratio. Sensitivity, specificity and accuracy were 83.1, 90 and 0.94% for Nt-pro BNP. Conclusions: Evaluation of NT-proBNP was important for detection of LVDD in COPD patients, which was correlated with disease severity. Echocardiographic assessment of COPD patients, especially in combination with NT-proBNP can be considered as good diagnostic tools of LVDD in COPD.



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