Pathologic Involvement oftheLeft Ventricle inChronicCorPulmonale

To determine whether or not the left ventricle is patholog ically involvedin patientswith chronicourpulmonale, right and left ventricular weights, wall thickness, myocyte di ameters, and percentage of fibrosis in 18 autopsied hearts were examined in patients with chronic pulmonary disease (CPD); ten had right ventricular hypertrophy on their electrocardiograms, and eight were without right ventric ular hypertrophy.Five with extracardiopulmonarydisease were used as controls. The weight of the right ventricle was significantly increased in CPD when compared to control subjects. Walls of both ventricles were significantly thickerin CPD. Myocytediametersof both ventricles were significantly greater in CPD. The percentage of fibrosis in the right venticle was significantly greater in CPD. The percentage of fibrosis in the left ventricle was significantly greater only in patients with right ventricular hypertrophy. We concluded that the left ventricle was also involved pathologically in patients with chronic cor pulmonale in the end stage of the disease. (Chest 1990; 98:794-806) CPD = chronic pulmonary disease; RVH right ventricular hypertrophy T he impairment of left ventricular function has been documented in some patients with chronic cor pulmonale. In patients with severe chronic cor pulmonale, left ventricular end-diastolic pressure in creases,' and left ventricular ejection fraction is de pressed both at rest and with exercise.2 Such impair ments of left ventricular function have been considered to be brought about by sustained hypoxia or interventricular septal bulging towards the left ventricle due to right ventricular pressure overload.3 In addition, some authors have reported pathologic changes of the left ventricle. Studies by Scott and Garvin4 and by Miche1son@demonstrated frequently observed left ventricular wall thickening in patients with chronic cor pulmonale. Samad and Noehren6 found focal degenerative changes in left ventricular myocardium in some autopsies ofpatients with chronic cor pulmonale. These reports suggest that pathologic involvement in the left ventricle is also one of the causes of the impairment of left ventricular function in chronic cor pulmonale; however, the pathologic involvement has not been extensively studied in