Pulmonary Hypertension and Cardiac Dysfunction Across GOLD Stages in Stable COPD: An Echocardiographic Cross-Sectional Study

Background: Cardiovascular abnormalities may remain clinically silent in stable chronic obstructive pulmonary disease (COPD), yet substantially influence symptoms and prognosis. Data describing the full echocardiographic spectrum across spirometric GOLD grades are limited.

Objective: To determine the prevalence and pattern of cardiac dysfunction in clinically stable COPD and assess its relationship with airflow limitation and selected clinical factors.

Materials and Methods: This cross-sectional study included 385 adults aged 40 years or older with stable COPD. Participants underwent post-bronchodilator spirometry, clinical evaluation, electrocardiography, and two-dimensional transthoracic echocardiography. Major outcomes included echocardiographic pulmonary hypertension, right ventricular (RV) dilatation, reduced tricuspid annular plane systolic excursion (TAPSE), left ventricular (LV) systolic and diastolic dysfunction, and valvular abnormalities. Associations were examined using chi-square tests, Spearman correlation, and multivariable logistic regression.

Results: Mean age was 61.69 ± 8.03 years and 84.9% were male. Mild, moderate, severe, and very severe COPD accounted for 17.9%, 34.0%, 30.6%, and 17.4% of participants, respectively. Echocardiographic pulmonary hypertension was present in 79.2%, RV dilatation in 14.5%, reduced TAPSE in 22.1%, any LV diastolic dysfunction in 64.7%, and moderate/severe tricuspid regurgitation in 48.8%. At least one cardiac comorbidity was identified in 91.4%. Pulmonary hypertension increased from 44.9% in mild COPD to 100% in very severe COPD, while reduced TAPSE increased from 0% to 71.6% (both p<0.001). FEV1% predicted correlated inversely with pulmonary artery systolic pressure (rho=-0.72, p<0.001); FEV1/FVC correlated positively with TAPSE (rho=0.621, p<0.001). Each one-grade increase in GOLD severity independently increased the odds of any cardiac comorbidity (adjusted OR 5.60, 95% CI 2.62-11.97) and pulmonary hypertension (adjusted OR 4.54, 95% CI 2.78-7.42).

Conclusion: Cardiac involvement was highly prevalent in stable COPD and showed a strong severity-related gradient. Echocardiography may be particularly valuable in moderate-to-very-severe COPD and in patients with clinical features suggesting cardiocirculatory compromise.