الفهرس 
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)Only 14 pages are availabe for public view
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Abstract
T
he present study was conducted upon 70 stable COPD patients at Abbassia Chest Hospital, from December 2016 to December 2017. Cardiopulmonary exercise test used for assessment of their functional capacity and echocardiography for diagnosis of diastolic dysfunction and its grading.
Exclusion criteria:
i. COPD patients with exacerbations
ii. Patients with known history of cardiac disorder as myocardial ischemia, valvular heart disease and atrial fibrillation.
iii. Exclusion criteria for CPET including unstable cardiac disease e.g (myocardial infarction <3 months, uncontrolled hypertension, angina), neuromuscular conditions that would interfere with the exercise test, and/or if they were unable to follow instructions.
All included patients were subjected to the following:
1. Full history taking and baseline Modified Medical Research Council (mMRC) dyspnea scores were performed to all patients.
2. Full clinical examination.
3. Arterial blood gases
4. Laboratory investigations: CBC, BUN, Cr, ALT, AST.
5. Radiological examination: chest x ray, CT chest.
6. Pulmonary function tests:
Spirometry
Cardiopulmonary exercise test:
All patients performed an incrementally progressive, symptom-limited exercise test on a treadmill exercise test (MGC DIAGNOSTICS-CPX; Ultima Series; USA) using Bruce protocol.
7. Electrocardiogram.
8. Echocardiography:
Echocardiography studies were done in echo unit Ain shams university (GE Vivid S6 ultrasound system)
The current study revealed:
There is statistically significant inverse relation between diastolic dysfunction severity and COPD severity among study cases.
Grades of diastolic dysfunction had statistically significant inverse correlation with amount of oxygen consumption (VO2 ml/kg/min) at anaerobic threshold, maximal exercise and percentage of functional capacity (VO2 MAX/Predicted %).
Meanwhile there was significant negative relation between GOLD grades of COPD and resting oxygen consumption (ml/kg/min) changed to be significant positive relation at anaerobic threshold, maximal exercise and its percentage from predicted. Meaning that milder grades of COPD fail to tolerate exercise by increasing their oxygen consumption in comparison to those with higher grades of COPD.
Minute ventilation had inverse relation with both grades of diastolic dysfunction and COPD, during exercise and at maximal exercise.
There is statistically significant positive correlation between GOLD grades of COPD and diastolic dysfunction grades with ventilatory equivalent for carbon dioxide at anaerobic threshold and at maximal exercise.
There is significant positive correlation between oxygen pulse and diastolic dysfunction grades at rest changed to be significant negative correlation at anaerobic threshold and at maximal exercise; meaning that higher grades of diastolic dysfunction fail to tolerate exercise by increasing their oxygen pulse.
Significant positive relation between FEV1% and diastolic dysfunction severity.
Relation of FEV1% with pulmonary artery systolic pressure was non significant.
from the present study, it is concluded that:
High prevalence of left ventricular diastolic dysfunction in COPD patients.
Both COPD and left ventricular diastolic dysfunction aggrevate symptoms of each other.
Presence of left ventricular diastolic dysfunction in COPD patients impair their functional capacity even mild grade of left ventricular diastolic dysfunction.
Severity of left ventricular diastolic dysfunction in COPD patients mainly affect their oxygen consumption (ml/kg/min) and oxygen pulse at maximal exercise.
Functional impairement may be found even in mild COPD because of presence of high grade of left ventricular diastolic dysfunction.
Ventilation in COPD patients is affected by severity of both COPD and left ventricular diastolic dysfunction.