Left ventricular diastolic dysfunction (LVDD) is a common cophenomenon in chronic obstructive pulmonary disease (COPD) with or without the presence of known risk factors for the same. The risk factors for this diastolic dysfunction can be as varied as cardiomyopathy, hypertension, diabetes mellitus, hypothyroidism, restrictive infiltrative diseases like amyloidosis, etc. The significance of LVDD in advanced COPD with or without the known risk factor is largely unknown, and ischemic heart diseases not apparent in conventional investigations has been implicated as a cause or association of LVDD in the advanced COPD population. Although it is not yet largely recognized, the LVDD has been claimed to be causally associated with COPD exacerbation. Moreover, coexistence of LVDD is observed with more frequent and prolonged hospitalization from exacerbation of COPD. Hence, the treatment of the condition (LVDD) should turn out to be beneficial.
We have diagnosed LVDD according to the standard criteria in nine of 15 consecutive cases of COPD and treated them with diltiazem or bisoprolol (a cardioselective beta blocker) after noting their COPD assessment test (CAT) score. After a uniform follow up of 3 months, we looked for the change in the lung function by spirometry and the quality of life in terms of CAT score again. All the patients were stable (historically without any exacerbation or change in medication) on standard pharmacotherapy in the preceding 2 months before treating for LVDD, with the comorbidities being taken care of. Measurement of the resting pulse rate and the arterial oxygen saturation were also done before and after therapy for LVDD.
The mean age and the mean body mass index were 65.00 ± 6.36 years and 22.46 ± 3.38, respectively, and the difference in FEV1, resting pulse rate, resting arterial oxygen saturation and the CAT score are charted in Table 1.
The results revealed that there was no difference in FEV1, resting pulse rate and arterial oxygen saturation before and after the treatment of LVDD along with the standard pharmacotherapy for COPD, but the quality of life has changed significantly in terms of CAT scoring. CAT scoring is a validated tool to assess the quality of life in COPD patients that tallies very well with the COPD version of St. George's Respiratory Questionnaire.
It can, therefore, be inferred that LVDD in COPD needs treatment and that the effect is significantly beneficial to the patients. Further research is warranted immediately to validate the finding alongside determining the best possible way of intervention for the LVDD in the patients of advanced COPD.
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