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Oxidative Stress, Inflammation and Echocardiographic Parameters as Predictors for Stress Right Ventricular Diastolic Dysfunction in NonSevere Chronic Obstructive Pulmonary Disease

Zheina Cherneva*, Radostina Cherneva

Stress induced Right Ventricular DD (RVDD) precedes the clinical/echocardiographic manifestation of pulmonary hypertension and is an early marker of pulmonary vasculopathy. The timely detection of RVDD is important for the early diagnosis of pulmonary vasculopathy in COPD management and physical activity improvement. The simultaneous performance of stress-echocardiography and cardio-pulmonary exercise testing may provide early diagnosis of RVDD in COPD patients with exertional dyspnoea. Oxidative stress and inflammation are both present in Chronic Obstructive Pulmonary Disease (COPD). In addition to intrathoracic and haemodynamic pressure oscillations, they have been considered as main factors for both right and left ventricular diastolic remodeling. The role of 8-isoprostane, prostaglandin E2 and resistin for stress induced Right Ventricular DD (RVDD) in non-severe COPD is still elusive. We evaluated 104 patients with non-severe COPD (FEV1>50%) and preserved left ventricular ejection fraction >50%. Patients underwent Cardio-Pulmonary Exercise Testing (CPET). Our results showed a high prevalence of stress induced RVDD-78% of the patients, while only 14% showed RVDD at rest. Patients with stress RVDD demonstrate similar levels of oxidative stress (of 8-isoprostane). Prostaglandine E2 and resistin correlate to RV E/e’>6, but none of them is an independent predictor for it. None of these biomarkers could be used as a predictor for stress RVDD in clinical practice. In contrast, in multivariate regression analysis the echocardiographic parameters - RAVI, RVWT, RV E/A and RV E/e’ ratio at rest independently predict stress RVDD