The Effects Of Chronic Heart Dysfunction In Patients With Coronary Heart Disease And With Chronic Obstructive Pulmonary Disease On Right Ventricular Function And Structural Changes

Objective:To investigate the effects of chronic heart dysfunction in patients with coronary heart disease (CHD) and patients with chronic obstructive pulmonary disease(COPD) on right ventricular function and structural changes, different cardiac function class CHD patients and the COPD patients with or without cor pulmonale were studied, and the differents were compared to find the dysfunction of right heart early.Methods:According to the cardiac function(NYHA),68 CHD patients hospitalized in Dec.2008-Feb.2010 were divided to classⅡgroup(n=32) and classⅢgroup(n=36).86 COPD patients hospitalized at the same time were divided to cor pulmonale group (n=40) and with out cor pulmonale group(n=46).50 volunteers were control group. pulmonary artery dimension(PAD), right ventricular end- diastolic dimension (RVED), right ventricular anterior wall thickness(RVAWT), left ventricular eject fraction, left and right ventircular Tei index (L,R-Tei index) and pulmonary artery pressure(PAP) were measured and compared.Results:PAD, RVED and RVAWT between two CHD groups were similar to control group (p>0.05). The R-Tei index of cardiac function in classⅡgroup (0.62±0.19) and classⅢgroup(0.66±0.13) were higher than control group (p<0.05). The Tei index was not significantly different between the two CHD groups. The R-Tei index was significantly negative related to LVEF, and was significantly positive related to L-Tei index. There were 23,10 and 6 subjects observed Tricuspid valve reflux in CHD classⅢgroup, classⅡgroup and control group. Estimated PAP was 22.11±6.23mmHg,23.24±5.21mmHg,22.56±2.78mmHg. PAD, RVED and RVAWT of COPD with and without cor pulmonale group were significantly higher than the control group,. The R-Tei index of COPD with(0.86±0.18) and without cor pulmonale group (0.67±0.12) was significantly higher than the control group(0.29±0.09). R-Tei index of COPD with cor pulmonale was significantly hither than that of COPD without cor pulmonale group. PAD, RVED, RVAWT and R-Tei index of COPD with cor mulmonale group were significantly higher than those of the COPD without cor pulmonale group and two CHD groups. There was no significant difference between the COPD without cor pulmonale group and two CHD groups.Conclusions:There were no significant change of RVED, RVAWT, PAD in CHD patients (cardiac function classⅡandⅢ). R-Tei index was significantly negative related to LVEF, was significantly positive related to L-Tei index. Right heart failure was observed in CHD patients with left heart failure. R-Tei index can early evaluate the right heart function in patients with CHD and predict mortality and development of heart function. The R-Tei index of two COPD groups were significantly higher than the control group, and the R- Tei index of COPD with cor pulmonale group was significantly higher than the group without cor pulmonale (P<0.05). R- Tei index can evaluate the systolic and diastolic function of right ventricle in patients with COPD earlier.