Right and left ventricular dysfunction in patients with severe pulmonary disease

Chest. 1998 Mar;113(3):576-83. doi: 10.1378/chest.113.3.576.


Objective: To determine the prevalence of right and left ventricular dysfunction in a prescreened population of patients with severe pulmonary disease, and to analyze the relationship between right and left ventricular function.

Design: Retrospective record review of 434 patients with severe pulmonary disease.

Patients: Patients with end-stage pulmonary disease, including alpha1-antitrypsin deficiency emphysema, COPD, cystic fibrosis (CF), idiopathic pulmonary fibrosis, and pulmonary hypertension (primary and Eisenmenger's syndrome), who were evaluated for lung transplantation between January 1993 and December 1995.

Measurements: Pulmonary function tests, arterial blood gases, radionuclide ventriculography, two-dimensional transthoracic echocardiography, pulmonary hemodynamics, coronary angiography.

Results: Right ventricular dysfunction (right ventricular ejection fraction [RVEF] <45%) was present in 267 patients (66%), but the prevalence was highest (94%) in patients with pulmonary vascular disease. Among the patients with airway or parenchymal lung disease, the prevalence ranged from 59% in COPD to 66% in CF. In contrast, left ventricular dysfunction (left ventricular ejection fraction [LVEF] <45%) was present in only 6.4%, but it, too, was most common in the group with pulmonary hypertension (19.6%). In the groups with parenchymal or airway disease, the prevalence was 3.6%, and there was no statistical difference among the four diagnoses (alpha1-antitrypsin deficiency emphysema; COPD; CF; idiopathic pulmonary fibrosis). LVEF showed a significant correlation with RVEF (r=0.44; p<0.05), and left ventricular dysfunction was associated with the presence of moderate-to-severe tricuspid regurgitation but not with coronary artery disease. In a subset of patients with both right and left ventricular dysfunction who subsequently underwent lung transplantation, RVEF and LVEF increased pari passu after transplantation.

Conclusion: The prevalence of right ventricular dysfunction is high in patients with end-stage pulmonary disease, but the prevalence of left ventricular dysfunction is relatively low. Left ventricular dysfunction appears to be related to right ventricular dysfunction, perhaps through ventricular interdependence.

MeSH terms

  • Adult
  • Cystic Fibrosis / complications
  • Female
  • Humans
  • Hypertension, Pulmonary / complications
  • Lung Diseases / complications*
  • Lung Diseases, Obstructive / complications
  • Male
  • Middle Aged
  • Pulmonary Emphysema / complications
  • Pulmonary Fibrosis / complications
  • Pulmonary Heart Disease / diagnosis
  • Retrospective Studies
  • Stroke Volume
  • Tricuspid Valve Insufficiency / complications
  • Ventricular Dysfunction / diagnosis*
  • Ventricular Dysfunction / etiology
  • alpha 1-Antitrypsin Deficiency / complications