Echocardiographic Evaluation of Right Heart Structure and Function in Patients with Chronic Obstructive Pulmonary Disease
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder characterized by persistent airflow limitation and important extrapulmonary consequences. Cardiovascular involvement, particularly right ventricular (RV) remodeling, right atrial (RA) enlargement and elevated pulmonary artery pressure, may develop because of chronic hypoxic pulmonary vasoconstriction, pulmonary vascular remodeling and increased RV afterload. Early identification of right-heart abnormalities may help recognize patients requiring closer cardiopulmonary evaluation. Objective: To evaluate right-heart structural and functional abnormalities in patients with COPD using transthoracic echocardiography and to assess their association with GOLD spirometric grade. Methods: This cross-sectional observational study included 100 patients aged 40–80 years with clinically stable COPD. COPD was confirmed by post-bronchodilator spirometry using a post-bronchodilator FEV1/FVC ratio <0.70, and airflow limitation was categorized according to GOLD spirometric grades. Demographic and clinical characteristics, smoking history, duration of COPD and selected comorbidities were recorded. Transthoracic echocardiography assessed RA diameter and area, RV basal and mid-cavity diameters, tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), estimated pulmonary artery systolic pressure (PASP) and tricuspid regurgitation (TR). TAPSE <17 mm and RV FAC <35% were considered abnormal. Elevated PASP was interpreted as an echocardiographic finding rather than definitive pulmonary hypertension. Data were analyzed using SPSS version 26.0. Results: The mean age was 62.5 ± 8.4 years and 72% were male. Mean smoking exposure was 28.3 ± 12.1 pack-years and COPD duration was 7.8 ± 4.5 years. GOLD grades 1–4 comprised 10%, 35%, 40% and 15%, respectively. RA enlargement was present in 42%, while RV basal and mid-cavity dilation occurred in 35% and 28%. Mean TAPSE was 19.2 ± 3.1 mm and RV FAC was 38.5 ± 6.2%. Reduced TAPSE and RV FAC occurred in approximately one-third of patients. Mean estimated PASP was 42.7 ± 10.1 mmHg, with elevated PASP in approximately 40%. TR was present in 70% (mild 45%, moderate 20%, severe 5%). Right-heart abnormalities increased progressively across GOLD grades. Conclusion: Right-heart remodeling, impaired RV systolic function, elevated echocardiographic pulmonary pressure and functional TR were common in COPD and increased with worsening GOLD spirometric grade. Echocardiographic assessment may help identify patients requiring closer cardiopulmonary evaluation and further risk assessment.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7203588879