Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease and Pulmonary Fibrosis: Prevalence and Hemodynamic Differences in Lung Transplant Recipients at Transplant Center's Referral Time

Abstract

Introduction. Single or bilateral lung transplantation is a therapeutic procedure for endstage lung diseases. In particular, in cases of chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis, patients can be referred to the transplant center late and with important comorbilities. Pulmonary hypertension (PH) associated with lung diseases not only is an index of poor outcome but also is an indication for bilateral procedure. Methods. We conducted a retrospective observational study. We analyzed right heart catheterization in a consecutive series of patients who underwent lung transplantation from 2006 to 2014 for end-stage COPD and pulmonary fibrosis. Results. We included in the study 73 patients (35 with fibrosis and 38 with COPD); prevalence of PH was higher in the COPD group (84.3% vs 31.4%), and with worse hemodynamic parameters (mean pulmonary artery pressure [30.3 mm Hg vs 24.1 mm Hg]). The majority of COPD patients presented mild or moderate PH, and fibrosis patients showed normal pulmonary arterial pressures. Conclusions. COPD patients are referred to the Transplant Center with a higher prevalence of PH because of an echocardiographic screening or a late referral, but many patients survive on the waiting list and undergo the procedure. On the other hand, patients transplanted with interstitial diseases have a lower prevalence of PH; this can be explained by an earlier referral or a higher mortality on the waiting list and a more aggressive and rapidly progressing disease.

Chrysene accelerates the proceeding of chronic obstructive pulmonary disease with the aggravation of inflammation and apoptosis in cigarette smoke exposed mice

“…Subsequently, typical pathological changes including the damaged alveolar walls and pulmonary bullae were observed after the exposure to both CS and Chry at an earlier stage of experiment, and all these abnormalities in structure have been documented to impair the gas exchange and eventually lead to the dysfunction of lung. 25 Moreover, the collagen depositions, elevated expression of α-SMA and reduced E-cadherin were found in CS + Chry exposed mice at the first 2 week according to our findings. Briefly, it has been reported that myofibroblast accumulation, which is characterized with increased α-SMA and collagen deposition, is a key feature for pathological airway remodeling of COPD.…”

“…and all these abnormalities in structure have been documented to impair the gas exchange and eventually lead to the dysfunction of lung. 25 Moreover, the collagen depositions, elevated expression of a-SMA and reduced E-cadherin were found in CS þ Chry exposed mice at the first 2 week according to our All data were presented as mean + SD of six separate experiments. Versus control group: # P < 0.05, ## P < 0.01, ### P < 0.001, #### P < 0.0001; Versus CS group, *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001.…”

Study of incidence of heart failure in COPD exacerbation- A study in north India

“…RV failure confers a poor prognosis in COPD. 10,11 In our study the incidence of HTN, DM and CAD was 12.34%, 27.16%, 9.87% respectively in the respiratory failure group whereas in the non respiratory failure group the incidence was 19.67%, 26.22% and 9.83% respectively. In a study conducted in Spain by Almagro et al 12 (2010) they found that 55% of the patients had hypertension, 26% diabetes mellitus, 27% chronic heart failure, and 17% ischemic heart disease.…”

Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care

“…Among hospitalized patients with moderate/severe COPD, 48% demonstrated at least one abnormality of RV structure/function, with RV enlargement being the most common (29.9%) (119). Finally, overt RV failure confers a poor prognosis in COPD (121,122). The treatment of HF due to right ventricle failure in COPD is mostly symptomatic, with diuretics being useful in managing the effects of volume overload (44); other drugs (e.g., those used in primary pulmonary hypertension) do not seem beneficial in patients with COPD (123).…”