Right Heart Function in COPD

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Pulmonary hypertension is a common complication in patients with severe hypoxic COPD, but the elevation in pulmonary arterial pressure (PAP) is usually relatively mild, although its presence indicates a poor prognosis. A minority of patients have severe pulmonary hypertension, whose prognosis is very poor with the development of right heart failure. Pulmonary hypertension in COPD is thought to result from hypoxic pulmonary vasoconstriction leading to structural remodeling of all layers of the pulmonary arterial walls. The simple hypothesis that hypoxemia in patients with chronic lung disease results in pulmonary hypertension, which adversely affects right ventricular function and hence increases morbidity and decreases exercise tolerance, leading to the development of peripheral edema and increased mortality, is still somewhat controversial. Whether therapeutic interventions that directly affect PAP or right ventricular function have a significant effect on long-term survival in patients with pulmonary hypertension secondary to hypoxic lung disease is still a matter of debate. Furthermore, whether such interventions will have an effect on symptoms or exercise tolerance remains unproven. Present therapies are limited to the correction of hypoxemia over the long term, which has been shown to have proven benefits on survival. Further studies are required of more specific pulmonary vasodilators or therapies to improve right ventricular function in these patients.