_______________________________________________________________________________________________________________________________ 3568 https://www.id-press.eu/mjms/index ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2019 Nov 15; 7(21):3568-3573. https://doi.org/10.3889/oamjms.2019.848 eISSN: 1857-9655 Clinical Science Cardiovascular Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Echocardiography Changes and Their Relation to the Level of Airflow Limitation Daniela Buklioska-Ilievska 1* , Jordan Minov 2 , Nade Kochovska-Kamchevska 1 , Biljana Prgova-Veljanova 1 , Natasha Petkovikj 1 , Vladimir Ristovski 1 , Marjan Baloski 1 1 General Hospital, “8th September”, Skopje, Republic of Macedonia; 2 Institute for Occupational Health of Republic of Macedonia - WHO Collaborating Center, Skopje, Republic of Macedonia Citation: Buklioska-Ilievska D, Minov J, Kochovska- Kamchevska N, Prgova-Veljanova B, Petkovikj N, Ristovski V, Baloski M. Cardiovascular Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Echocardiography Changes and Their Relation to the Level of Airflow Limitation. Open Access Maced J Med Sci. 2019 Nov 15; 7(21):3568-3573. https://doi.org/10.3889/oamjms.2019.848 Keywords: Airflow limitation; Chronic obstructive pulmonary disease; Doppler echocardiography; Pulmonary hypertension; Ventricular dysfunction *Correspondence: Daniela Buklioska Ilievska. General Hospital, ”8th September”, Skopje, Republic of Macedonia. E-mail: dbuklioska@yahoo.com Received: 16-Aug-2019; Revised: 24-Sep-2019; Accepted: 25-Sep-2019; Online first: 14-Oct-2019 Copyright: © 2019 Daniela Buklioska-Ilievska, Jordan Minov, Nade Kochovska-Kamchevska, Biljana Prgova- Veljanova, Natasha Petkovikj, Vladimir Ristovski, Marjan Baloski. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Abstract AIM: To compare the frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. METHODS: Study population included 120 subjects divided into two groups. Group 1 included 60 patients with COPD (52 male and 8 females, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire, pulmonary evaluation (dyspnea severity assessment, baseline and post- bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. RESULTS: We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 mm vs. 24.4 ± 4.3 mm; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (33.3% vs. 0%; P = 0.0004) showing a linear relationship with the severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs 64.8 ± 2.7%; P = 0.0000) with no correlation with severity of airflow limitation. CONCLUSION: Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with the severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention. Introduction Chronic obstructive pulmonary disease (COPD) is accompanied by comorbidities which have a significant impact on its prognosis. Furthermore, cardiovascular comorbidities are considered as a major cause for hospitalization and mortality in COPD patients [1], [2], [3], [4], [5], [6]. COPD affects pulmonary blood vessels, right ventricle and left ventricle leading to right ventricular dysfunction, left ventricular dysfunction, pulmonary hypertension (PH) and cor pulmonale [7]. COPD patients have two to three-fold increased risk for hospitalisation due to cardiovascular morbidity compared to patients without COPD [8]. Also, 20-30% of all patients with chronic heart failure have COPD [9], [10]. Shortness of breath and reduced effort tolerance is present in both diseases, so cardiac failure in COPD often remains unrecognised and symptoms are attributed to COPD exacerbations. The reason is that two dimensional (2D) Doppler echocardiography as a diagnostic method for heart failure is not implemented in primary care and is not a standard diagnostic procedure for pulmonologists controlling these patients [9], [11]. Mortality from cardiovascular diseases (CVD) is about 30% and in patients with mild and moderate COPD, the most common cause of hospitalisation and mortality is cardiovascular disease. Lung Health Study showed that reduction of 10% of forced expiratory volume in one second (FEV 1 ) value in the patients with mild and moderate COPD increases the risk of fatal cardiovascular events up to 30% and of non-fatal coronary events up to 20% [12]. As it was mentioned in the Towards a Revolution in COPD Health (TORCH) study, in patients with severe COPD, CVD