Right and left ventricular dysfunction in patients with severe pulmonary disease

To determine the prevalence of right and left ventricular dysfunction in a prescreened population of patients with severe pulmonary disease, and to analyze the relationship between right and left ventricular function.

Retrospective record review of 434 patients with severe pulmonary disease.

Patients with end-stage pulmonary disease, including alpha1-antitrypsin deficiency emphysema, COPD, cystic fibrosis (CF), idiopathic pulmonary fibrosis, and pulmonary hypertension (primary and Eisenmenger's syndrome), who were evaluated for lung transplantation between January 1993 and December 1995.

Pulmonary function tests, arterial blood gases, radionuclide ventriculography, two-dimensional transthoracic echocardiography, pulmonary hemodynamics, coronary angiography.

Right ventricular dysfunction (right ventricular ejection fraction [RVEF] <45%) was present in 267 patients (66%), but the prevalence was highest (94%) in patients with pulmonary vascular disease. Among the patients with airway or parenchymal lung disease, the prevalence ranged from 59% in COPD to 66% in CF. In contrast, left ventricular dysfunction (left ventricular ejection fraction [LVEF] <45%) was present in only 6.4%, but it, too, was most common in the group with pulmonary hypertension (19.6%). In the groups with parenchymal or airway disease, the prevalence was 3.6%, and there was no statistical difference among the four diagnoses (alpha1-antitrypsin deficiency emphysema; COPD; CF; idiopathic pulmonary fibrosis). LVEF showed a significant correlation with RVEF (r=0.44; p<0.05), and left ventricular dysfunction was associated with the presence of moderate-to-severe tricuspid regurgitation but not with coronary artery disease. In a subset of patients with both right and left ventricular dysfunction who subsequently underwent lung transplantation, RVEF and LVEF increased pari passu after transplantation.

The prevalence of right ventricular dysfunction is high in patients with end-stage pulmonary disease, but the prevalence of left ventricular dysfunction is relatively low. Left ventricular dysfunction appears to be related to right ventricular dysfunction, perhaps through ventricular interdependence.