Publication:

Emerging role of transesophageal echocardiography in severe chronic obstructive pulmonary disease

Background Pulmonary hypertension (PH) secondary to chronic obstructive pulmonary disease (COPD) has a prevalence from 20 to 91% depending on the definition of PH (mPAP >20 versus >25 mmHg). Pulmonary vasoconstriction, pulmonary vascular remodeling, endothelial dysfunction, inflammation and destruction of the pulmonary vascular bed being the common mechanisms behind. Transthoracic echocardiograms (TTE) though the most important non-invasive tool to measure degree of PH, may give false negative results in severe COPD cases due to poor echo window. This could be overcome by doing transesophageal echocardiograms (TEE) in those cases, which is, though invasive but gives good results. The aim of the study was to evaluate the role of transesophageal echocardiography in COPD patients.

Methods Total 100 patients of COPD were evaluated for PH via TTE and TEE was performed in all those 33 patients whose TTE were non-confirmatory due to poor echo window.

Results There were 0% patient with poor echo window in COPD grade 1, 18.18% in grade 2, 42.2% and 39.39% in grade 3 and grade 4 respectively. P-value obtained was statistically significant P <0.001. Out of 33 COPD patients with poor echo window, In grade 3 and grade 4, 64.2% and 76.9% patients had TEE findings respectively while in grade1 and grade 2 0% and 33.33% patient had TEE finding.

Conclusions TTE though is an excellent tool for diagnosing  pulmonary artery hypertension in COPD patients, has its limitation especially in severe COPD cases due to poor echo window which may give false negative results. So TEE should be recommended in all those severe COPD cases that have poor echo window.