A Study of Functional Changes of the Right Heart in Patients of COPD Acute Exacerbation with Respiratory Failure

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a common and treatable disease characterized by progressive airflow limitation and tissue destruction. COPD has considerable effects on cardiac functions, primarily by affecting the pulmonary vasculature and then the right ventricle, along with the left ventricle. During acute exacerbations, hypoxemia and hypercapnia may contribute to pulmonary hypertension and right ventricular (RV) dysfunction, which adversely affect prognosis.
Methods: A prospective observational study was conducted on 61 patients admitted with acute COPD exacerbations to the respiratory intensive care unit (ICU) over a period of 6 months at a tertiary care hospital. After applying exclusion criteria, 56 patients were included. All underwent arterial blood gas (ABG) analysis, spirometry, and transthoracic echocardiography to assess RV systolic pressure (RVSP), pulmonary artery systolic pressure (PASP), right atrial size, RV ejection fraction (EF), fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE). Clinical status was assessed with the modified Medical Research Council (mMRC) scale, COPD assessment test (CAT), BODE index, and GOLD ABCD tool.
Results: Severe COPD patients exhibited higher PaCO₂ (72.6 ± 5.3 vs. 55.2 ± 3.5 mmHg), lower PaO₂ (56.5 ± 2.96 vs. 64.2 ± 4.6 mmHg), increased right atrial area (33.3 ± 6.5 vs. 21.5 ± 5.2 cm²), and elevated PASP (45.3 ± 3.5 vs.30.2 ± 2.3 mmHg) compared to moderate COPD. TAPSE was reduced, indicating RV dysfunction, and correlated positively with PaO₂ and negatively with PaCO₂.
Conclusion: COPD exacerbations were strongly associated with pulmonary hypertension and RV dysfunction. Echocardiographic evaluation of pulmonary pressures and right heart parameters provides essential prognostic information and should be integrated into COPD management.