Emphysema, Airflow Obstruction, and Left Ventricular Filling

To the Editor: Barr and colleagues (Jan. 21 issue) 1 speculate that the subclinical loss of the pulmonary capillary bed in patients with mild emphysema is responsible for left ventricular hypofilling, whereas hyperinflation of the lung has a role in very severe chronic obstructive pulmonary disease (COPD) only. We found hyperinflation of the lung to have a stronger association with left ventricular end-diastolic diameter than airflow obstruction or the diffusion capacity for carbon monoxide in 138 patients with COPD ranging from mild to very severe. 2 Therefore, we assume that hyperinflation has an effect on decreasing pulmonary vascular compliance that is mediated . . .