Clinical insights into pulmonary hypertension in chronic obstructive pulmonary disease

Abstract

Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). Little is known about the prevalence and clinical profiles of patients with COPD‐PH. We report the clinical characteristics, hemodynamic profiles, and prognosis in a large population of patients with COPD referred for right heart catheterization (RHC). We extracted data from all patients referred for RHC between 1997 and 2017 in Vanderbilt's deidentified medical record. PH was defined as mean pulmonary artery pressure >20 mmHg. Pre‐ and postcapillary PH were defined according to contemporary guidelines. COPD was identified using a validated rules‐based algorithm requiring international classification of diseases codes relevant to COPD. We identified 6065 patients referred for RHC, of whom 1509 (24.9%) had COPD and 1213 had COPD and PH. Patients with COPD‐PH had a higher prevalence of diabetes, atrial fibrillation, and heart failure compared with COPD without PH. Approximately 55% of patients with COPD‐PH had elevated left ventricle (LV) filling pressure. Pulmonary function testing data from individuals with COPD‐PH revealed subtype differences, with precapillary COPD‐PH having lower diffusion capacity of the lungs for carbon monoxide (DLCO) values than the other COPD‐PH subtypes. Patients with COPD‐PH had significantly increased mortality compared with COPD alone (hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.28–2.26) with the highest mortality among the combined pre‐ and postcapillary COPD‐PH subgroup (HR: 2.39; 95% CI: 1.64–3.47). PH is common among patients with COPD referred for RHC. The etiology of PH in patients with COPD is often mixed due to multimorbidity and is associated with high mortality, which may have implications for risk factor management.

Features of Atrial Fibrillation Pathogenesis and Prognosis in Chronic Obstructive Pulmonary Patients during the COVID-19 Pandemic

“…Polycythemia, contributing to an increase in blood viscosity, increases pulmonary resistance. It is the risk factor for developing thromboembolism, against which secondary pulmonary hypertension may occur [ 46 ]. In addition, pulmonary hypertension may worsen the condition in patients with AF and COPD by increasing right atrial overload or stretch in COPD patients [ 47 ].…”

Real‐world use of inhaled treprostinil for lung disease‐pulmonary hypertension: A protocol for patient evaluation and prescribing

“…These findings further emphasize the established discordance between randomized controlled trial and nontrial cohorts of lung disease-PH patients in which nontrial cohorts are often older with higher prevalence of comorbid disease and would therefore have been ineligible for clinical trial enrollment. [17][18][19] While the description of an older and predominately male Veteran population differs from the patients enrolled in INCREASE, reporting on this clinically vulnerable population with elevated morbidity risk 20,21 is critical, as previously highlighted in idiopathic PAH. 22 Furthermore, a protocolized approach to the assessment of compassionate use prescribing in select COPD-PH patients supports prescribers tasked with treatment decisions in this population and motivates ongoing prospective study of inhaled treprostinil in patients with obstructive lung disease.…”