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Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

¹ 1st Cardiology Dept, AHEPA University Hospital, ² Respiratory Failure Unit, Aristotle University of Thessaloniki, Thessaloniki, and ³ Dept of Pneumonology, Medical School, University of Thrace, Alexandroupolis, Greece.

CORRESPONDENCE: D. Bouros, Dept of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece. Fax: 30 2551076106. E-mail: bouros{at}med.duth.gr

Keywords: Diastole, Doppler echocardiography, idiopathic pulmonary fibrosis, left ventricular dysfunction

Received: August 7, 2007
Accepted November 26, 2007

It was hypothesised that, apart from right ventricular (RV) dysfunction, patients with idiopathic pulmonary fibrosis (IPF) also exhibit left ventricular (LV) impairment, which may affect disease progression and prognosis. The aim of the present study was to evaluate LV performance in a cohort of IPF patients using conventional and tissue Doppler echocardiography.

IPF patients exhibiting mild-to-moderate pulmonary arterial hypertension (mean age 65±9 yrs; n = 22) and healthy individuals (mean age 61±6 yrs; n = 22) were studied. Conventional and tissue Doppler echocardiography were used for the evaluation of RV and LV systolic and diastolic function.

In addition to the expected impairment in RV function, all patients showed a characteristic reversal of LV diastolic filling to late diastole compared with controls (early diastolic peak filling velocity (E)/late diastolic peak filling velocity 0.7±0.2 versus 1.5±0.1, respectively). Patients with IPF also exhibited lower peak myocardial velocities in early diastole (E_m; 5.7±1.1 versus 10.3±1.6 cm·s^–1, respectively), higher in late diastole (A_m; 8.9±1.3 versus 5.5±0.8 cm·s^–1, respectively), lower E_m/A_m ratio (0.6±0.1 versus 1.9±0.5, respectively) and higher E/E_m ratio (10.8±3 versus 6±0.6, respectively), all indicative of LV diastolic dysfunction. Moreover, LV propagation velocity was significantly lower in IPF patients (46±13 versus 83±21 cm·s^–1, respectively).

Physicians should be aware that patients with idiopathic pulmonary fibrosis exhibit early impairment of left ventricular diastolic function.