Clinical course and prognosis of chronic pulmonary emphysema with special reference to pulmonary circulatory disturbance.

Abstract

Clinical course and prognosis were studied in 103 patients with chronic pulmonary emphysema with special reference to clinical features and pulmonary hemodynamics, and in 78 patients of whom right heart catheterization was performed. The periods of the follow-up were between 1.5 and 10 years (4.4 years on an average).Thirty cases died during these periods and 73 cases were still alive. Details of 73 living patients in the clinical situation were "improved" in 25 cases (24.2%), "unchanged" in 32 cases (31.3%) and "worsen" in 16 cases (15.5%).Among 30 cases of "dead", 8 patients died from right heart failure, 5 died from probable right heart failure and the other 17 cases died from other causes such as infection, malignancy and et cetera.The results suggest that pulmonary hemodynamics, especially pulmonary artery mean pressure (PAm), is an important factor in predicting the prognosis of chronic pulmonary emphysema. Thus, any one of the following items can be taken as a valuable index for judgement of poor prognosis:(1) PAm of over 30 mm.Hg(2) Ecg of RVH following the ordinary criteria plus PAm of over 22mm.Hg(3) PaCO2 of over 50mm.Hg plus PAm of over 22mm.Hg(4) WP of over 8mm.Hg (especially of over 13mm.Hg) plus PAm of over 22mm.Hg(5) PVRI of over 600 dynes•sec.cm.-5/M.2 plus PAm of over 22mm.Hg(6) MBC of less than 35% plus PAm of over 22mm.Hg Either of the following items could be employed as a useful index for poor prognosis.(1') SaO2 of less than 88% plus marked ventilatory disturbance(2') RVd of over 8mm.Hg