Hemodynamic Changes in Chronic Obstructive Pulmonary Disease

Boushy, Samuel F.; North, Luceil B.

doi:10.1378/chest.72.5.565

Cited by 41 publications

(14 citation statements)

References 3 publications

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“…Although earlier studies suggested that emphysema, and consequent tissue destruction, leads to pulmonary hypertension, this contention is not supported by recent studies (10,32,33). Likewise, we found no significant correlation between the extent of emphysema and Ppa at least in patients with severe emphysema.…”

Section: Discussioncontrasting

confidence: 99%

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Matsuoka¹,

Washko²,

Yamashiro³

et al. 2010

Am J Respir Crit Care Med

166

158

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Rationale: Vascular alteration of small pulmonary vessels is one of the characteristic features of pulmonary hypertension in chronic obstructive pulmonary disease. The in vivo relationship between pulmonary hypertension and morphological alteration of the small pulmonary vessels has not been assessed in patients with severe emphysema. Objectives: We evaluated the correlation of total cross-sectional area of small pulmonary vessels (CSA) assessed on computed tomography (CT) scans with the degree of pulmonary hypertension estimated by right heart catheterization. Methods: In 79 patients with severe emphysema enrolled in the National Emphysema Treatment Trial (NETT), we measured CSA less than 5 mm 2 (CSA ,5 ) and 5 to 10 mm 2 (CSA 5210 ), and calculated the percentage of total CSA for the lung area (%CSA ,5 and %CSA 5-10 , respectively). The correlations of %CSA ,5 and %CSA 5-10 with pulmonary arterial mean pressure (Ppa) obtained by right heart catheterization were evaluated. Multiple linear regression analysis using Ppa as the dependent outcome was also performed. Measurements and Main Results: The %CSA ,5 had a significant negative correlation with Ppa (r 5 20.512, P , 0.0001), whereas the correlation between %CSA 5-10 and Ppa did not reach statistical significance (r 5 20.196, P 5 0.083). Multiple linear regression analysis showed that %CSA ,5 and diffusing capacity of carbon monoxide (DL CO ) % predicted were independent predictors of Ppa (r 2 5 0.541): %CSA ,5 (P , 0.0001), and DL CO % predicted (P 5 0.022). Conclusions: The %CSA ,5 measured on CT images is significantly correlated to Ppa in severe emphysema and can estimate the degree of pulmonary hypertension.Keywords: chronic obstructive pulmonary disease; emphysema; pulmonary hypertension; CT Pulmonary hypertension is an important predictor of mortality in chronic obstructive pulmonary disease (COPD) (1-3). Various factors, including endothelial dysfunction, inflammation, and hypoxia, have been recognized as potential contributors to the development of secondary pulmonary hypertension in emphysema, but its pathogenesis has not been fully clarified. Nevertheless, it is generally recognized that vascular remodeling of small pulmonary arteries is an essential morphological feature of pulmonary hypertension; narrowing and diminution of the small pulmonary vessels have been shown on conventional angiography in emphysema (4-6). However, to our knowledge, the in vivo relationship between pulmonary hypertension and the magnitude of small pulmonary vessel morphological change has not been quantitatively assessed in severe emphysema.A recent histological study suggested that vascular remodeling leads to reduced distensibility of small pulmonary vessels and that this remodeling is closely related to pulmonary hypertension (7). Such a decrease in distensibility of small pulmonary vessels may lead to increased pulmonary vascular resistance and elevated pulmonary vascular pressure. Therefore, we hypothesized that measurements of the total cross-sectional area of small ...

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Section: Discussioncontrasting

confidence: 99%

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Matsuoka¹,

Washko²,

Yamashiro³

et al. 2010

Am J Respir Crit Care Med

166

158

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“…This is in agreement with reports of many workers in this field [6,16,20,24,25], indicating that left-heart disease was not a prominent factor in our patients with COPD with regard to the mean values. Nevertheless, 5 of the 27 patients showed a disproportionately high pulmonary capil lary pressure during exercise, suggestingbut not proving -occult left-heart disease.…”

Section: Exercise Tolerance and The Relationship To Lung Function Andsupporting

confidence: 94%

“…In the early stage of the disease, pulmonary hypertension occurs predomi nantly during exercise [5,6,24). With time, right ventricular hypertrophy and failure, intensified by bronchial infections, can develop.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Gas Exchange and Central Hemodynamics at Rest and during Exercise in Patients with Chronic Obstructive Pulmonary Disease

Seibold¹,

Roth²,

Lippert³

et al. 1986

Respiration

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Right-heart catheterization and ergometry with arterial and mixed venous blood gas analysis were performed in 27 patients with a wide range of chronic obstructive pulmonary diseases. The purpose of the examination was to evaluate the risk in patients for lung surgery or to detect additional heart diseases. Patients who developed ex-ertional hypoxia (group 1) were compared with others who did not (group 2). In all patients the steady-state maximal workload was determined by ventilatory dysfunction. Both groups had normal values for mixed venous pO₂ and normal increase of the circulatory parameters during exercise. The patients with exertional hypoxia differed from the others in that they showed no decrease of venous admixture and alveolar-arterial oxygen gradient. In addition, these patients had increasing pCO₂ values at rest compared with exercise, indicating alveolar hypoventilation and ventilation-perfusion mismatching. Because of the good correlation of the absolute values of FEV₁ (forced expiratory volume in 1 s) with pulmonary artery pressures, parameters of gas exchange and working capacity, this lung function parameter seems to have a central role in predicting the functional state of patients with chronic obstructive disease. Ergometry and blood gas analysis should be performed in addition because these values cannot be predicted with the calculated postoperative FEV₁

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“…chronic bronchitis) type. These initial findings were recently contradicted by Boushy and North [4], who found normal cardiac outputs ir respective of low or severe functional scores for emphysema.…”

Section: Introductionmentioning

confidence: 89%

Hemodynamic Characteristics in Chronic Obstructive Lung Disease as Related to Cardiac Size

Hutsebaut¹,

Scano²,

García-Herreros³

et al. 1981

Respiration

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The hemodynamic adaptation during exercise was evaluated in 19 patients suffering from chronic obstructive lung disease. They were divided into two groups according to cardiac size on the X-ray (group 1, small; group 2, normal). A small cardio-thoracic ratio could be correlated with ‘emphysema’ assessed on the basis of hyperinflation and a low transfer test for CO. No clear-cut difference could be found between the two groups concerning the hemodynamic data at rest or during exercise. However, for all subjects, the cardiac output was found to be slightly related to the cardiac size (smaller cardiac output for smaller cardiac size). During exercise, a low cardiac output was characterized by a low oxygen transport and a high level of lactate. From this it is suggested that a small cardiac size, a classical feature of hyperinflation and emphysema, may lead to a low cardiac output. The explanation for these results is speculative, but variable hemodynamic profiles in chronic obstructive lung disease with or without hyperinflation may be related to the morphology of the cardiac chambers and to variable intrathoracic pressure regimes during respiration.

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Hemodynamic Changes in Chronic Obstructive Pulmonary Disease

Cited by 41 publications

References 3 publications

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Pulmonary Gas Exchange and Central Hemodynamics at Rest and during Exercise in Patients with Chronic Obstructive Pulmonary Disease

Hemodynamic Characteristics in Chronic Obstructive Lung Disease as Related to Cardiac Size

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