Right ventricular remodeling as an unfavorable feature in patients with chronic obstructive pulmonary disease combined with hypertension

Abstract

We investigated 69 patients with hypertension (HT) stage II in combination with chronic obstructive pulmonary disease (COPD) (GOLD 2, group B) in remission (57 males and 12 females ; mean age 55,80±5,51 years) who underwent 6-min walk test (6MWT), pulse oximetry, spirometry, chest X-ray, electrocardiography and echocardiography. IL-18 and IL-10 in the serum were determined by ELISA using a test system «Bender MedSystems, GmbH» (Austria). Worsening breathlessness, decreased tolerance to physical activity, reduction in oxygen saturation (SpO2) after 6MWT was associated with RV structural and functional impairment. Significant (p<0,05) differences in right heart chambers, indicating an increase in their overload, was found depending on the presence or absence of desaturation, i.e. decrease SpO2 during 6MWT more than 4% from baseline or below 90%: right atrial size - 39,79±2,27 mm vs. 35,83±5,02 mm; RV diameter - 27,10±2,22 mm vs. 28,37±2,40 mm; RV wall thickness - 5,58±0,57 mm vs. 5,22±0,61 mm; pulmonary artery to aorta ratio - 0,75±0,07 vs. 0,71±0,08. RV pressure overload (RV wall thickness > 5 mm and RV diameter < 30 mm) was associated with an imbalance of inflammatory response with increasing proinflammatory IL-18 and decreasing antiinflammatory IL-10. RV remodeling in response to pressure overload is often accompanied by maladaptive RV structural and functional impairment. Thus, RV remodeling with signs of overload by pressure was associated with increasing breathlessness, decreasing tolerance to physical activity, desaturation during 6MWT and imbalance of inflammatory response in patients with COPD combined with hypertension.