Elsevier

Respiratory Medicine

Volume 104, Issue 12, December 2010, Pages 1877-1882
Respiratory Medicine

Categorization and impact of pulmonary hypertension in patients with advanced COPD

https://doi.org/10.1016/j.rmed.2010.05.009Get rights and content
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Summary

Introduction

The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant.

Methods

A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed.

Results

4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4%, with pulmonary venous hypertension (PVH) accounting for an additional 17.2% of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = −1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = −1.91; p < 0.001). Both PH (HR 1.23 95%CI [1.01–1.50]) and PVH (HR 1.35 95%CI [1.11–1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95%CI [1.04–1.55], PVH: HR 1.40; 95%CI [1.13–1.73]).

Conclusion

PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.

Keywords

Chronic obstructive pulmonary disease
Functional status
Prevalence
Pulmonary hypertension
Six minute walk test

Abbreviations

6MWD
Six minute walk distance test
CI
Confidence interval
COPD
Chronic obstructive pulmonary disease
FEV1%
Forced expiratory volume in one second
FVC%
Forced vital capacity
HR
Hazard ratios
mPAP
Mean pulmonary artery pressure
OPTN
Organ procurement and tissue network
PAOP
Pulmonary artery occlusion pressure
PH
Pulmonary hypertension
PVH
Pulmonary venous hypertension
RHC
Right heart catheterization

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