15 February 2020 by RODRIGO HOYOS

The right ventricular ejection fraction (RVEF) for heart gammagraphy in patients with chronic obstructive pulmonary disease (COPD) in a third level hospital in the height of Quito-Ecuador

Introduction

Quito has 2,644,145 people. It’s located at 2,840 meters above sea level (m.a.s.l.). The group of patients with COPD, is a group of high demand in the Health Systems of the country, factors such as altitude level, RVEF, Hematocrit, directly influence. The RVEF by Radionuclide ventriculography or radionuclide angiography (MUGA) was used due to the high demand for echocardiograms in our hospital, despite not being recommended in the international consensus.

Materials and methods

Retrospective observational study, case series; with a population and known sample of 17 patients, inclusion criteria: patients with a diagnosis of COPD who attended the pneumonology external consultation of the Carlos Andrade Marín Specialties Hospital (HCAM), in 2016, in the city of Quito, Ecuador in 2016. The data obtained from the electronic medical history of the AS400 system, over 18 years old, both genders. Among the exclusion criteria: healthy patients, loss of data. The data was analyzed with the help of the Excel system, and SPPS.23.0, validating the right ventricular ejection fraction (RVEF), left ventricular ejection fraction, correlated with other variables: age, gender, hemodynamic values and residence in meters above the level of the sea (MASL) in each group of COPD according to its GOLD.

Results

  • The age range of patients who attended the consultation with a diagnosis of COPD was 51-88 years. Male gender with 70.6% (12;17) and female 29.4% (5;17), predominates COPD GOLD 2.
  • The majority of patients live in Quito between 1,001-3,000 m.a.s.l.. The LVEF was calculated in the ranges 21 and 80, and RVEF with a range between 24 and 66 mmHg and predominance of the NYHA II functional class.

Conclusions

  • The mean age in the case series is 51 years
  • The majority of patients are male and with COPD GOLD 2, with NYHA 2 functional class, live between 1,001 and 3,000 m.a.s.l.
  • There were no cases in NYHA 4 functional capacity or with COPD GOLD 4, they probably do not move from their homes.
  • The LVEF is not modified, it is maintained at normal values (above 50-55%)
  • The FEVD decreases progressively as the GOLD and altitude increase, however in the present case series there are normal values (above 40 to 45 %)
  • The etiology of PH in COPD is multifactorial
  • This series of cases is the beginning of future research to promote adequate education in chronic diseases of altitude and high altitude
  • The Multiple Gated Equilibrium Cardiac Blood Pool Scintigraphy technique (MUGA) for measuring RVEF in patients with COPD increases suspicion of right heart size increase and then to confirm with echocardiogram, cardiac magnetic resonance and right heart catheterization.

About the author


profile picture of RODRIGO HOYOS

RODRIGO HOYOS

PNEUMOLOGIST

CARLOS ANDRADE MARIN HOSPITAL AND DE LOS VALLES HOSPITAL

Ecuador

Key Contributors

Hoyos Paladines Rodrigo, Muñoz Torres Miriam, Ortega Moyano Elena Pneumology Technical Unit, Carlos Andrade Marín Specialty Hospital, Quito, Ecuador Cardiology Technical Unit, Carlos Andrade Marín Specialty Hospital, Quito, Ecuador


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