Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease.

Abstract

In 175 patients with chronic obstructive lung disease (157 chronic bronchitic and 18 emphysematous patients) exhibiting moderate to severe airway obstruction (mean FEV1/vital capacity = 40X2 + 11 1 %), cumulative survival rates calculated by the actuarial method were compared in subgroups according to the initial level of mean pulmonary artery pressure, pulmonary volumes, and arterial blood gases. Patients were catheterised between 1968 and 1972 and were followed for at least five years. The results emphasise the high prognostic value of PAP since survival rates after four and seven years were significantly lower in the subgroup with PAP > 20 mmHg (2.7 kPa).Certain other parameters ("driving" pressure across_the pulmonary circulation, FEV, and PaCo2) appear to be equally good at predicting survival as PAP in these obstructed patients. The effect of age should be taken into account in prognostic studies such as ours since survival rates were significantly lower in patients over 60 years of age. In 64 patients who underwent a second right heart catheterisation at least three years after the first (average delay: 5*5 + 2 years), the prognostic value of changes in PAP, arterial blood gases, and pulmonary volumes was studied but with the exception of Pao2 was unremarkable. Further studies are needed in this field.In chronic obstructive pulmonary disease (COPD) and especially in chronic bronchitis, the presence of cor pulmonale is associated with a poor prognosis.1-3 However pulmonary arterial hypertension is measurable and therefore easier to assess than cor pulmonale and prognostic studies have usually been related to the presence of pulmonary hypertension and its severity.4-7 Most of these studies have included cases of severe COPD with a high proportion of patients having experienced episodes of rightsided heart failure. Only one recent study7 was devoted to the prognosis of pulmonary hypertension in a large series of patients with mild or moderate airflow obstruction. Follow-up data were generally not taken into account.We have investigated the prognostic value of mean pulmonary artery pressure (PAP) taking into account the influence of age, and compared it with other functional data (FEV1, arterial blood gases) in our series of patients with moderate to severe airway obstruction. The actuarial method was used to assess survival rate. In 64 patients who underwent a second

Polymorphism of the Serotonin Transporter Gene and Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

“…Moreover, several reports have suggested that a mean PAP Ͼ29 mm Hg may be associated with significantly shorter survival of patients with COPD. 2,3 It is noteworthy that in our study, such high levels of PAP were observed only in LL patients. Therefore, the presence of the LL genotype should identify patients at risk for developing severe PH during progression of COPD.…”

“…1 Although PH is usually mild to moderate in COPD, it is associated with a poor prognosis. 2,3 Long-term oxygen therapy improves the prognosis of patients with COPD and stabilizes pulmonary artery pressure (PAP). 4,5 However, even in patients receiving long-term oxygen therapy, PH is the strongest prognostic factor, independent of the severity of airflow limitation or hypoxemia.…”

Pulmonary hypertension in COPD: results from the ASPIRE registry

“…T he development of pulmonary hypertension (PH) in chronic lung diseases such as chronic obstructive pulmonary disease (COPD) has both functional and prognostic implications [1,2]. PH in COPD (PH-COPD) is usually mild to moderate with preserved cardiac output, and evolves slowly alongside the progression of lung disease and hypoxaemia [3].…”

Sildenafil Inhibits Hypoxia-Induced Pulmonary Hypertension

“…2 Hypoxia also plays a significant role in the pathogenesis of the pulmonary hypertension that accompanies chronic obstructive airway disease. 3 Pulmonary hypertension is a serious clinical problem with significant morbidity and mortality, but apart from continuous oxygen administration, there is currently no satisfactory treatment for the condition.…”