Background and Objectives: Chronic obstructive pulmonary disease (COPD) significantly impacts morbidity and mortality, often due to cardiovascular comorbidities that are frequently overlooked. This study examines the prevalence of left ventricular dysfunction in COPD patients and its association with disease severity, hypoxemia, and exacerbation frequency. Materials and Methods: COPD patients (n = 114) were evaluated using spirometry and transthoracic echocardiography. Statistical analysis utilized Student’s t-test, chi-square test, and multivariable logistic regression with 1000 bootstrapping iterations, considering p < 0.05 as significant differences. Results: Most patients were classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III (40.4%) and stage IV (44.7%). Diastolic dysfunction was present in 67.5% of the patients (Grade 1: 53.5%, Grade 2: 13. 2%, Grade 3: 0.0.9%), while 18.4% exhibited systolic dysfunction (LVEF < 50%). The prevalence of diastolic dysfunction increased significantly, from 41.2% in GOLD stage II to 92. 2% in GOLD stage IV (p < 0.001). Independent predictors of diastolic dysfunction included GOLD stage IV (Odds Ratio [OR]: 5.39, 95% Confidence Interval [CI]: 1. 42–23.35, p < 0.001), older age (OR: 1.02 per year, 95% CI: 1.01–1.04, p = 0.025), and a history of frequent exacerbations (OR: 1.09 per event, 95% CI: 1.01–1.17, p = 0.039). Systolic dysfunction correlated significantly with GOLD stage IV (OR: 1.83, p = 0.014), oxygen saturation below 88% (OR: 3.12, p = 0.036), and having three or more exacerbations (OR: 4.18, p = 0.008). Conclusions: This study reveals a high prevalence of left ventricular dysfunction in COPD patients, linked to disease severity, hypoxemia, and frequent exacerbations. It supports incorporating complementary echocardiographic assessments in managing advanced COPD, especially for those with frequent exacerbations or oxygen desaturation.