Author + information
- Gurkan Acar1,
- Hasan Kahraman2,
- Murat Akkoyun1,
- Metin Kilinc3,
- Cemil Zencir4,
- Edagani Yusufoglu3,
- Imran Dirnak1,
- Hatice Sahin2,
- Soner Olmez5 and
- Idris Ardic1
The aim of this study was to evaluate atrial electromechanical delay, inflammation, and oxidative stress parameters, and was to investigate clinical and laboratory characteristics affecting atrial electromechanical delay in patients with chronic obstructive pulmonary disease (COPD).
Forty-three patients with COPD (60.5±9.9 years) and 50 healthy controls (59.6±7.1 years) were included. Using tissue Doppler imaging (TDI), atrial electromechanical delay intervals were measured from lateral mitral annulus (cPA lateral) and lateral tricuspid annulus (cPA tricuspid), and corrected for heart rate. Left and right ventricles functions were examined using conventional and TDI. Plasma levels of high sensitive C-reactive protein (hsCRP) and oxidative stress parameters were measured. Factors associated with atrial electromechanical delay were evaluated by stepwise multiple regression analysis.
Clinical characteristics and spirometric findings for the two groups are presented in Table 1. Age, sex, body mass index, body surface area, and systolic and diastolic blood pressure are similar between the groups (p>0.05). Smoking status and heart rate at rest are significantly higher in patients with COPD compared to the controls (p<0.05). Conventional and tissue Doppler echocardiographic parameters for the groups are shown in Table 2. Left atrium volume index, sPAP, mitral E/A ratio, and right ventricle myocardial performance index differ significantly between the groups (p<0.05). Measurements of atrial electromechanical delay, oxidative stress, and inflammation markers between COPD patients and controls are presented in Table 3. cPA lateral, cPA septum, and cPA tricuspid are significantly higher in patients with COPD compared to controls (p<0.05). Also, hsCRP and malondialdehide are significantly higher in patients with COPD (p<0.05). cPA lateral is independently related to lateral Em/Am ratio (β=-0.29, p=0.004) and FEV1/FVC ratio (β=-0.24, p=0.02). cPA tricuspid is independently related only to FEV1/FVC ratio (β=-0.51, p<0.001).
This study shows that atrial electromechanical delay intervals are prolonged in patients with COPD. Prolongation of atrial electromechanical delay may be related with inflammation, oxidative stress, and FEV1/FVC ratio in these patients.
|Patients with COPD (n = 43)||Controls (n = 50)||P value|
|Females n (%)|
|Smoking status, n (%)||38 (88)||11 (22)||<0.001|
|Heart rate, beats/min||74.5±13.6||69.6±10.2||0.048|
COPD, chronic obstructive pulmonary disease; BMI, body mass index; BSA, body surface area; SBP, systolic blood pressure; DBP, diastolic blood pressure; FEV1, forced expiratory volume in the first second; FVC, forced vital capacity.
|LV end-diastolic diameter, mm||47.6±4.2||48.6±3.5||0.23|
|LV ejection fraction, (%)||65.7±2.7||66.4±3.1||0.23|
|LV mass index, g/m2||88.9±15.4||93.4±16.7||0.18|
|Left atrial dimension, mm||35.2±3.9||36.1±3.6||0.22|
|Left atrial volume index, ml/m2||19.9±6.7||24.9±9.9||0.006|
|Right atrial area, cm2||15.0±6.5||14.4±2.9||0.58|
|Right ventricle basal, mm||36.5±5.0||36.5±4.0||0.96|
|Right ventricular fractional area change, (%)||42±5.4||46.3±6.1||0.08|
COPD, chronic obstructive pulmonary disease; LV, left ventricle; TAPSE, tricuspid annular plane systolic excursion; sPAP, systolic pulmonary artery pressure; MPI, myocardial performance index.
|Patients (n=43)||Controls (n=50)||P value|
|cPA lateral, ms||69.8±10.4||62.2±8.9||<0.001|
|cPA septal, ms||50.0±7.5||40.9±6.2||<0.001|
|cPA tricuspid, ms||45.4±10.2||33.5±5.1||<0.001|
|Glutathione peroxidase, U/gHb||1.93±1.50||2.04±1.91||0.77|
|Superoxide dismutase, U/gHb||8677.5±5574.0||9267.7±5538.5||0.61|
cPA, corrected atrial electromechanical delay (time interval from the onset of P wave on surface ECG to the beginning of A wave interval with tissue Doppler imaging); hsCRP, high sensitive C-reactive protein.