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CRITICAL CARE AND TRAUMA

Left Ventricular Performance and Dimensions in Patients with Severe Emphysema

From the Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.

Address Correspondence and reprint requests to Sven-Erik Ricksten, MD, PhD, Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden. Address e-mail to sven-erik.ricksten{at}aniv.gu.se.

BACKGROUND: Concomitant heart dysfunction during the course of chronic obstructive pulmonary disease is well recognized. The prevailing view is that mainly the right side of the heart is involved. We evaluated left ventricular (LV) function and dimensions in patients with severe emphysema.

METHODS: Patients with severe emphysema undergoing lung volume reduction surgery were studied after anesthesia induction (n = 10). Non-emphysematous patients scheduled for lobectomy served as controls (n = 10). LV dimensions were measured with patients in the supine position by transesophageal two-dimensional echocardiography and systemic hemodynamics by a pulmonary artery thermodilution catheter, before and during central blood volume expansion by passive leg elevation.

RESULTS: Baseline cardiac index (–25%), stroke volume index (SVI, –32%) stroke work index (–34%) and LV end-diastolic area index (EDAI, –33%) were significantly (P < 0.001) lower in the emphysema group. Passive leg elevation increased SVI and LV area ejection fraction more in the emphysema group than in controls (P < 0.05). The SVI/ pulmonary capillary wedge pressure and the SVI/EDAI relationships were significantly (P < 0.05) higher in the emphysema group compared to controls (2.2 ± 0.71 vs 0.6 ± 0.2 mL/mm Hg x m² and 5.8 ± 0.89 vs 2.8 ± 0.8 mL/cm² x m², respectively). Preload-recruitable stroke work (stroke work index/EDAI), a load-independent index of systolic LV function, did not differ between the two groups.

CONCLUSION: The LV in patients with severe emphysema is hypovolemic, and operates on a steeper portion of the LV function curve, while indices of systolic function are not significantly impaired compared to non-emphysematous controls.