Abstract
Study Objectives
The etiology and prevalence of pulmonary hypertension (PH) in patients with stable chronic obstructive pulmonary disease (COPD) is uncertain. This study was done to determine the prevalence of PH in stable COPD outpatients and to evaluate the relationship between PH and indices of pulmonary function.
Design
The study was a retrospective review of outpatients with COPD and PH defined as a history of cigarette smoking, pulmonary function tests (PFTs) that met GOLD criteria for airway obstruction, an echocardiogram within 6 months of PFTs, and a left ventricular ejection fraction (LVEF) >55%. Of the 159 individuals who met all inclusion criteria, 105 had a sufficient tricuspid regurgitant jet to measure systolic pulmonary artery pressure (sPAP). PH was defined as sPAP ≥36 mmHg.
Measurements and Results
The prevalence of PH was 60% (63/105) in the study group. The mean sPAP in patients with PH was 45 ± 6 mmHg. COPD patients with PH were older (71.1 ± 11.8 vs. 63.7 ± 10.2 years, P = 0.001), had lower FEV1% predicted (51.8 ± 18.8 vs. 62.7 ± 20.5%, P = 0.006), a higher RV/TLC (0.55 ± 0.10 vs. 0.48 ± 0.11, P = 0.001), and a lower % predicted DLCO (59.6 ± 19.5% vs. 71.9 ± 24.9%, P = 0.006). Only age (P < 0.002) and prebronchodilator FEV1% predicted (P < 0.006) predicted PH by logistic regression analysis. No differences were observed in gender, BMI, smoking status, pack years, total lung capacity (TLC), or residual volume (RV).
Conclusion
PH is common in COPD. Older individuals and those with more airway obstruction are at greater risk for developing PH.
Similar content being viewed by others
References
Mannino DM, Braman S (2007) The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc 4:502–506
Jemal A, Ward E, Hao Y, Thun M (2005) Trends in the leading causes of death in the United States, 1970–2002. JAMA 294(10):1255–1259
Weitzenblum E, Sautegeau A, Ehrhart M et al (1984) Long-term course of pulmonary arterial pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis 130:993–998
Weitzenblum E, Hirth C, Ducolone A et al (1981) Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease. Thorax 36:752–758
Oswald-Mammosser M, Weitzenblum E, Quoix E et al (1995) Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure. Chest 107:1193–1198
Wuertemberger G, Zielinsky J, Sliwinsky P et al (1990) Survival in chronic obstructive pulmonary disease after diagnosis of pulmonary hypertension related to long-term oxygen therapy. Lung 168:S762–S769
Kessler R, Faller M, Fourgaut G et al (1999) Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 159:158–164
Higham MA, Dawson D, Joshi J et al (2001) Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD. Eur Respir J 17:350–355
Higenbottam T (2005) Pulmonary hypertension and chronic obstructive pulmonary disease: a case for treatment. Proc Am Thorac Soc 2:12–19
Miller MR, Hankinson J, Brusasco V et al (2005) Standardisation of spirometry. Eur Respir J 26:319–338
Badesch DB, Champion HC, Sanchez et al (2009) Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol 54:S55–S66
Falk JA, Kadiev S, Criner GJ et al (2008) Cardiac disease in chronic obstructive pulmonary disease. Proc Am Thorac Soc 5:543–548
Matheson MC, Raven J, Johns DP et al (2007) Associations between reduced diffusing capacity and airflow obstruction in community-based subjects. Respir Med 101:1730–1737
Thabut G, Dauriat G, Stern JB et al (2005) Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest 127:1531–1536
Scharf SM, Iqbal M, Keller C et al (2002) Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med 166:314–322
Kessler R, Faller M, Weitzenblum E et al (2001) “Natural history” of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease. Am J Respir Crit Care Med 164:219–224
Lam CS, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ, Redfield MM (2009) Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 119(20):2663–2670
Dallari R, Barozzi G, Pinelli G et al (1994) Predictors of survival in subjects with chronic obstructive pulmonary disease treated with long-term oxygen therapy. Respiration 61(1):8–13
McGhan R, Radcliff T, Fish R et al (2007) Predictors of rehospitalization and death after a severe exacerbation of COPD. Chest 132:1748–1755
Oswald-Mammosser M, Apprill M, Bachez P et al (1991) Pulmonary hemodynamics in chronic obstructive pulmonary disease of the emphysematous type. Respiration 58:304–310
Williams IP, Boyd MJ, Humberstone AM et al (1984) Pulmonary arterial hypertension and emphysema. Br J Dis Chest 78:211–216
Chaouat A, Bugnet AS, Kadaoui N et al (2005) Severe pulmonary hypertension and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 172:189–194
Chaouat A, Savale L, Chouaid C et al (2009) Role for interleukin-6 in COPD-related pulmonary hypertension. Chest 136(3):678–687
Sun XG, Hansen JE, Oudiz RJ et al (2003) Pulmonary function in primary pulmonary hypertension. J Am Coll Cardiol 41:1028–1035
Bishop JM, Csukas M (1989) Combined use of non-invasive techniques to predict pulmonary arterial pressure in chronic respiratory disease. Thorax 44:85–96
Sims MW, Margolis DJ, Localio AR et al (2009) Impact of pulmonary artery pressure on exercise function in severe COPD. Chest 136:412–419
Butler J, Schrijen F, Henriquez A et al (1988) Cause of the raised wedge pressure on exercise in chronic obstructive pulmonary disease. Am Rev Respir Dis 138:350–354
Sciurba FC, Rogers RM, Keenan RJ et al (1996) Improvement in pulmonary function and elastic recoil after lung-reduction surgery for diffuse emphysema. N Engl J Med 334:1095–1099
Criner GJ, Scharf SM, Falk JA, National Emphysema Treatment Trial Research Group et al (2007) Effect of lung volume reduction surgery on resting pulmonary hemodynamics in severe emphysema. Am J Respir Crit Care Med 176(3):253–260
Wright JL, Petty T, Thurlbeck WM (1992) Analysis of the structure of the muscular pulmonary arteries in patients with pulmonary hypertension and COPD: National Institutes of Health nocturnal oxygen therapy trial. Lung 170:109–124
Naeije R, Barbera JA (2001) Pulmonary hypertension associated with COPD. Crit Care 5:286–289
Wilkinson M, Langhorne CA, Heath D et al (1988) A pathophysiological study of 10 cases of hypoxic cor pulmonale. Q J Med 66:65–85
Peinado VI, Barbera JA, Abate P et al (1999) Inflammatory reaction in pulmonary muscular arteries of patients with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med 159:1605–1611
Timms RM, Khaja FU, Williams GW (1985) Hemodynamic response to oxygen therapy in chronic obstructive pulmonary disease. Ann Intern Med 102:29–36
Nocturnal Oxygen Therapy Trial Group (1980) Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med 93:391–398
Chatila WM, Thomashow BM, Minai OA, Criner GJ, Make BJ (2008) Comorbidities in chronic obstructive pulmonary disease. Proc Am Thorac Soc 5(4):549–555
Berger M, Haimowitz A, Van Tosh A et al (1985) Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 6:359–365
Yock PG, Popp RL (1984) Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70:657–662
Arcasoy SM, Christie JD, Ferrari VA et al (2003) Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 167:735–740
Laaban JP, Diebold B, Zelinski R et al (1989) Noninvasive estimation of systolic pulmonary artery pressure using Doppler echocardiography in patients with chronic obstructive pulmonary disease. Chest 96:1258–1262
Tramarin R, Torbicki A, Marchandise B et al (1991) Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study. Working Group on Noninvasive Evaluation of Pulmonary Artery Pressure. European Office of the World Health Organization, Copenhagen. Eur Heart J 12:103–111
Bach DS, Curtis JL, Christensen PJ et al (1998) Preoperative echocardiographic evaluation of patients referred for lung volume reduction surgery. Chest 114:972–980
Stolz D, Rasch H, Linka A, Di Valentino M, Meyer A, Brutsche M, Tamm M (2008) A randomised, controlled trial of bosentan in severe COPD. Eur Respir J 32(3):619–628
Blanco I, Gimeno E, Munoz PA, Pizarro S, Gistau C, Rodriguez-Roisin R, Roca J, Barberà JA (2010) Hemodynamic and gas exchange effects of sildenafil in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Am J Respir Crit Care Med 181(3):270–278
Rao RS, Singh S, Sharma BB, Agarwal VV, Singh V (2011) Sildenafil improves six-minute walk distance in chronic obstructive pulmonary disease: a randomised, double-blind, placebo-controlled trial. Indian J Chest Dis Allied Sci 53(2):81–85
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fayngersh, V., Drakopanagiotakis, F., Dennis McCool, F. et al. Pulmonary Hypertension in a Stable Community-Based COPD Population. Lung 189, 377–382 (2011). https://doi.org/10.1007/s00408-011-9315-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-011-9315-2