Chronic obstructive pulmonary disease (COPD) exacerbation is a frequent cause of hospital admissions. In one-third of patients, exacerbations have no known cause. We studied whether the presence of diastolic dysfunction (DD) in this subgroup of patients is associated with longer duration of hospitalization and more frequent exacerbations.Retrospective chart review of 139 patients with COPD, 84 with DD, and 55 with normal diastolic function hospitalized for acute COPD exacerbation between November 2004 and December 2007 was done. Diastolic dysfunction was defined by the presence of relaxation, filling, or distensibility abnormalities of the left ventricle on transthoracic echocardiogram.Patients with DD had increased length of stay compared with patients without DD (mean: 4.02 +/- 1.8 days vs 3.24 +/- 1.20 days; P = 0.005). Patients with DD had 1.28 exacerbations requiring hospitalization per patient-year compared with 0.67 in the normal diastolic function group (P = 0.0067).Patients with COPD and DD had prolonged and more frequent hospitalizations for COPD exacerbations. These findings suggest that DD, a surrogate for increased left ventricular filling pressure, is common in patients with COPD exacerbations and may be associated with increased frequency of hospitalization.