A COMPARITIVE STUDY OF PRE AND POST TREATMENT ECG AND ECHO FINDINGS IN ACUTE EXACERBATION OF COPD PATIENTS

Muthukumaran, Manu Mohan, *Tom Devasia, Aswini Kumar Mohapatra and Ashok Kumar Y G.

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by progressive airflow limitation. COPD is associated with significant comorbidities like cardiac disease which is common. COPD patients experience frequent exacerbations which mitigate change in existing management. Pulmonary artery hypertension is common in COPD. This study was conducted to assess the changes in Electrocardiogram (ECG) and Echocardiogram pre and post exacerbation of COPD. COPD males with age more than 40 years without significant comorbidities who were admitted due to exacerbation were included in the study. ECG and Echocardiogram was performed at the baseline and on one month of follow up. Spirometry was performed at the baseline when patients were stabilized. 108 patients were included in this study. Majority of our patients were of grade III (severe) (46.3%) and grade IV COPD (very severe) (38.8%) classes based on post bronchodilator FEV1% on spirometry as per GOLD criteria. We could not find any significant changes in ECG, pre and post exacerbation of COPD, except normalization of sinus tachycardia. At baseline, mild PAH was observed in 88 patients(81.48%) with mean RVSP=38.59mmHg,moderate PAH was observed in 17 patients(15.74%) with mean RVSP=52.47 mmHg and severe PAH was observed in 3 patients (2.77%) with mean RVSP=70.33mmHg. While correlating spirometry with RVSP at the baseline, mild PAH was common in grade III (51.13%), whereas severe PAH were common in grade III and grade IV COPD (64.7 & 100% respectively). We found statistically significant decrease in right ventricular systolic pressure (RVSP) following treatment of exacerbation of COPD. Echocardiography screening of COPD patients is beneficial to assess the pulmonary artery pressure and identify patients with severe pulmonary artery hypertension, who may benefit with additional medications including phosphodiesterase inhibitors for those with severe PAH.

Keywords: spirometry, phosphodiesterase, COPD.