Association Between Left Ventricular Diastolic Dysfunction and Chronic Obstructive Pulmonary Disease Severity: A Cross-Sectional Study

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is frequently accompanied by cardiovascular comorbidities, notably left ventricular diastolic dysfunction (LVDD). Due to overlapping symptoms between LVDD and COPD-related dyspnea, cardiac involvement may go undetected. The association between COPD severity and LVDD has not been fully elucidated. Objective: To determine the prevalence of LVDD and assess its association with the severity of COPD in affected patients. Methodology: This cross-sectional analytical study was conducted in Peshawar, from September 2024 to August 2025. A total of 394 clinically stable COPD patients were consecutively recruited. COPD diagnosis was confirmed using post-bronchodilator spirometry in accordance with GOLD criteria. Transthoracic echocardiography assessed left ventricular systolic and diastolic function, regional contractility, and right ventricular systolic pressure. Results: The mean age of participants was 61.4 ± 8.2 years, with 84.5% being male. LVDD was identified in 246 patients (62.4%). Among those with LVDD, 189 (76.8%) exhibited grade 1 and 57 (23.2%) exhibited grade 2 dysfunction; no cases of grade 3 or 4 dysfunction were observed. LVDD was present in 55.8% of GOLD 2, 68.4% of GOLD 3, and 63.2% of GOLD 4 patients. There was no significant association between GOLD severity and LVDD (p=0.208). Older age was significantly associated with LVDD (p=0.002). FVC was significantly lower among patients with segmental contractility abnormalities (p=0.002), but was not associated with LVDD. Conclusion: LVDD was prevalent among patients with COPD, primarily as mild dysfunction, but was not significantly associated with spirometric measures of COPD severity. Age demonstrated a significant association with LVDD, underscoring the importance of cardiovascular assessment in this population.