COPD, Emphysema, Right Heart Dysfunction
Conditions
Brief summary
Heart-lung interactions remain misunderstood whereas pulmonary and cardiac pathologies are very commonly associated. Emphysema by increasing intrathoracic pressure appears to affect cardiac function. Interestingly, previous studies have shown a link between the telediastolic volume of the right ventricle (measured by RMI) and the intensity of emphysema. Our hypothesis is that the emphysema by increasing intrathoracic pressure leads to or accentuates right cardiac diastolic dysfunction by decreasing compliance and cardiac preload. To verify this hypothesis the investigators will perform KT loop procedures in order to acquire intracardiac pressure/volume curves before and after lung volume reduction. The pressure/volume curves allow the analysis of systolic and diastolic function, cardiac contractility and loading conditions.
Interventions
None listed
Sponsors
University Hospital, Montpellier
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* At least 40 years * A smoking history * Smoking cessation ≥ 6 months * FEV1/FVC ≤ 0,7 * Severe emphysema (destruction ≥ 50%) * Peak tricuspid regurgitation velocity \< 2,8 m/s or presence of other echocardiographic PH signs * 15% ≤ FEV1post ≤ 50% * Residual volume ≥ 175% predicted * TLC ≥ 100% predicted * Optimal medical management * 150m ≤ 6MWD ≤ 500m * mMRC ≥ 2 * Physical activity ≥ 2/Week (≥ 30minutes)
Exclusion criteria
* ≥2 hospitalizations/year for EACOPD * Recent EACOPD (≤ 3months) * ≥ 50ml mucus/day * PAPm ≥35mmHg * PaCO2 ≥ 55mmHg * Bubble ≥ 1/3 hemithorax * Lung fibrosis, bronchiectasis, lung cancer, homolateral surgery * Left ventricular ejection fraction ≤ 45%, unstable heart disease * Life expectancy ≤ 1 year * Contraindication to anesthesia * Allergy to nitinol or silicone * Corticotherapy ≥ 10mg/day * Patient under legal protection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Estimate the change in right diastolic cardiac function after reduction of emphysema | 1 day | Estimate the change in right diastolic cardiac function after reduction of emphysema : assessed by the change in the slope end diastolic pressure volume relationship (EDPVR mmHg/ml) obtained by KT Loop procedure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Estimate the change in right cardiac contractility | 1 day | Estimate the change in right cardiac contractility before and after reduction of emphysema assessed by the slope end systolic pressure volume relationship (mmHg/ml), obtained by KT Loop procedure. |
| Estimate ventriculo-arterial coupling | 1 day | Estimate ventriculo-arterial coupling before and after reduction of emphysema assessed by the Ees/Ea ratio, obtained by KT Loop procedure |
| Estimate the change in right systolic heart function | 1 day | Estimate the change in right systolic heart function before and after reduction of emphysema assessed by the cardiac output (L/min), the stroke volume (ml), the end systolic pressure (mmHg), the end systolic volume (mmHg), obtained by KT Loop procedure |
| Assessing exercice performance | 1 day | Assessing exercice performance by the 6 minutes walk test before and after reduction of emphysema. |
| Evaluate the evolution of respiratory function | 1 day | Evaluate the evolution of respiratory function before and after reduction of emphysema assessed by the FEV1 (Liters and % of predicted value), the FVC (Liters and % of predicted value), the RV (Liters and % of predicted value), the TLC (Liters and % of predicted value) obtained by spirometry/plethysmography. |
| Evaluate the evolution of symptoms assessed | 1 day | Evaluate the evolution of symptoms assessed by the Mmrc questionnaire and the CATCOPD questionnaire before and after reduction of emphysema. |
Countries
France
Contacts
Primary ContactArnaud Bourdin, MD PhD
Outcome results
None listed