Cor Pulmonale In Patients Research Articles

Pathological findings in respiratory organs and blood circulation in patients with isolated DRTB and DRTB/HIV/AIDS co-infection (according to autopsy data).

Tuberculosis remains a major global health concern, especially in the context of emerging drug-resistant strains and the high prevalence of HIV/AIDS. Understanding the pathomorphologic changes associated with DRTB and its coinfection with HIV/AIDS is crucial for designing effective diagnostic, preventive, and therapeutic interventions. The objectives of this study were to assess the pathomorphologic changes, investigate lung function and blood circulation, and explore risk factors and clinical predictors associated with cor pulmonale in patients with DRTB and DRTB/HIV/AIDS co-infections. The study included 72 patients, with 28 having isolated DRTB and 44 having DRTB/HIV/AIDS co-infections. Microscopic examination of lung tissue samples from isolated DRTB patients revealed fibrous and productive changes with inflammatory infiltration. Histological examination of the myocardium in these patients showed hypertrophy and diffuse cardiosclerosis. Patients with DRTB/HIV/AIDS co-infections exhibited extensive destructive changes in lung tissue, along with dystrophy of cardiomyocytes and focal lymphohistiocytic infiltration in the myocardium. The frequency of cor pulmonale formation was significantly higher in the co-infection group (22.7%) compared to the isolated DRTB group (10.7%). Histological samples suggested that co-infection with HIV/AIDS exacerbates myocardial damage caused by DRTB. This research demonstrates the distinct pathomorphologic changes observed in the lung tissue and myocardium of patients with isolated DRTB and DRTB/HIV/AIDS co-infections. The study findings support the association between co-infection and increased risk of cor pulmonale development. Understanding the mechanisms underlying these differences will help identify potential therapeutic targets to mitigate myocardial damage in patients with DRTB and its co-infection.

Acute cor pulmonale in patients with acute respiratory distress syndrome: A comprehensive review.

Acute respiratory distress syndrome (ARDS)-related acute cor pulmonale (ACP) is found in 8%-50% of all patients with ARDS, and is associated with adverse hemodynamic and survival outcomes. ARDS-related ACP is an echocardiographic diagnosis marked by combined right ventricular dilatation and septal dyskinesia, which connote simultaneous diastolic (volume) and systolic (pressure) overload respectively. Risk factors include pneumonia, hypercapnia, hypoxemia, high airway pressures and concomitant pulmonary disease. Current evidence suggests that ARDS-related ACP is amenable to multimodal treatments including ventilator adjustment (aiming for arterial partial pressure of carbon dioxide < 60 mmHg, plateau pressure < 27 cmH2O, driving pressure < 17 cmH2O), prone positioning, fluid balance optimization and pharmacotherapy. Further research is required to elucidate the optimal frequency and duration of routine bedside echocardiography screening for ARDS-related ACP, to more clearly delineate the diagnostic role of transthoracic echocardiography relative to transesophageal echocardiography, and to validate current and novel therapies.

A study on clinical manifestations, radiological features, electrocardiographic and echocardiographic changes in various lung diseases associated with cor-pulmonale in patients attending Government General Hospital, Kakinada

Cor-pulmonale is an alteration in the structure and function of right ventricle secondary to many broncho-pulmonary vascular diseases and from different chest wall abnormalities. The development of PAH has an important prognostic role, as it significantly increases the risk of hospitalization and is associated with reduced survival.100 patients of cor-pulmonale confirmed by clinical, radiological and electrocardiographic manifestations from outpatient and inpatients in Pulmonology Department, Government General Hospital, RMC, Kakinada, over a period of November 2018-November 2019 were included in the study.Out of 100 study cases, most affected age group is 51-60 years, males were more affected than females maybe because of the fact number of smokers were male. Out of 100, seventy patients were smoker, of which 63 were male and 7 were female. Almost every patient of cor-pulmonale presented with dyspnea and cough and had features suggestive of RHF. On ECG, p-pulmonale was the most common finding followed by right axis deviation for cor-pulmonale. On ECHO, RVSP&amp;#62;60mmHg is found in 56%cases. Radiologically, 48% cases of cor-pulmonale were secondary to chronic bronchitis and emphysema.Echocardiographic screening of all patients with chronic lung disease especially the middle age males and the smokers will benefit in early detection of disease and initiation of treatment, thus improving their prognosis. A combined clinical, radiological, ECG andechocardiographic findings can give clue about progression of PAH and cor-pulmonale.

Risk Factors Associated with Development of Pulmonary Arterial Hypertension and Corpulmonale in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease is an important cause of morbidity and mortality globally. The onset of pulmonary hypertension and corpulmonale is associated with decreased survival in patients with COPD. Objective: To assess risk factors associated with the development of pulmonary hypertension and corpulmonale and to identify high-risk phenotypes who may need early evaluation and intervention. Methods: Consecutive adult patients with COPD were evaluated for factors influencing the development of pulmonary hypertension and corpulmonale which included symptomatology, hospitalization in the previous year, MMRC dyspnea grade, SGRQ score, 6 minute walk test, ABG, CRP, spirometry and echocardiography. Results: We found Pulmonary Hypertension in 36(30%) patients and 27(22.5%) had corpulmonale. On multivariate analysis, we found PaO2 ≤75 mm Hg and six minute walk test &lt;80% predicted to be significantly associated with the development of Pulmonary hypertension and we found hospitalization in the previous year to be significantly and independently associated with the development of corpulmonale. Conclusion: We observed hospitalization in the previous year was an independent risk factor for the development of corpulmonale and six-minute walk test &lt;80% predicted, PaO2 &lt;75 mm Hg were independent risk factors for the development of pulmonary hypertension.

Intracardiac hemodynamic abnormalities in patients with sarcoidosis

The aim of this study was to evaluate intracardiac hemodynamic abnormalities in patients with pulmonary sarcoidosis and to investigate relevant factors. Methods. The study involved 42 patients with chronic pulmonary sarcoidosis. Chest computed tomography (CT), echocardiography, body plethysmography, spirometry, 6-minute walking test, and measurements of lung diffusing capacity (DLCO), blood gases and blood C-reactive protein (CRP) were performed in all patients. Results. Chronic cor pulmonale was detected in 26.2% of patients. The right heart diastolic dysfunction was found in 14.3% of patients, the left heart diastolic dysfunction was found in 23.8% of patients, the mean pulmonary artery pressure (mPAP) was increased in 19% of patients. The right ventricular diameter was found to be related to the inspiratory bronchial resistance (Rin) (R = 0.480; p = 0.02), the intrathoracic gas volume (ITGV) (R = –0.670; p = 0.001), DLCO(R = 0.438; p = 0.013), and pulmonary fibrosis. The right heart systolic function (TAPSE) was related to DLCO(R = 0.518; p = 0.006), the total lung capacity (TLC) (R = 0.639; p = 0.001) and pulmonary fibrosis. The increased mPAP was related to the extension of disseminated lung lesions (R = 0.716; p = 0.018), blood oxygen partial pressure (R = 0.486; p = 0.017) and CRP level. The 6-min distance was related to Rin, the right ventricular diameter, parameters of the right heart diastolic function (tricuspid E / A ratio) (R = 0.486; p = 0.01), and ITGV (R = 0.494; p = 0.006). Conclusion. The development of cor pulmonale in patients with pulmonary sarcoidosis was related to DLCO, Rin and pulmonary fibrosis. The extension of disseminated lung lesions, hypoxemia and increased CRP were related to pulmonary hypertension. Different factors associated with cor pulmonale and pulmonary hypertension in sarcoidosis could prompt further investigation of different phenotypes of this disease with the intrinsic central hemodynamic abnormalities.

The relationship between acidosis and hypercapnia with Cor pulmonale in patients with chronic obstructive pulmonary disease

Introduction: Cor pulmonale or right ventricular (RV) enlargement is cardiovascular complication of the chronic obstructive pulmonary disease (COPD). Hypoxic pulmonary vasoconstriction, hypercapnia, acidosis and pulmonary vascular remodeling are suggested as possible mechanisms of cor pulmonale. In this study, we aimed to evaluate the correlation between acidosis and hypercapnia with corpulmonale in patients with COPD. Methods: In this cross-sectional analytical study, 100 patients (56 men and 44 women with mean age of 66.53 ± 10.63 years) with moderate to severe COPD exacerbation were included. Complete history taking and physical examination as well as atrial blood gas, pulmonary function test (PFT) and echocardiography were performed. Disease severity was defined according to global initiative for obstructive lung disease (GOLD), Modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) criteria. Patients with cor pulmonale were defined and findings were compared between patients with and without cor pulmonale. Results: Forty-two patients had cor pulmonale. There was no significant difference in hypercapnia between groups. Cor pulmonale patients, compared to non-cor pulmonale, had significantly lower forced expiratory volume in the first second (FEV1) (P = 0.020), higher tricuspid regurgitation (TR) (P = 0.001) and pulmonary hypertension (P = 0.020). There was significantly negative correlation between RV thickness with FEV1/forced vital capacity (FCV) (r = -0.239, P = 0.010) and RV size with FEV1/FVC (r = -0.312, P = 0.002) and positive correlation with partial pressure of carbon dioxide (PaCO2) (r = 0.312, P = 0.002) and bicarbonate (HCO3) (r = 0.258, P = 0.009). Conclusion: Cor pulmonale in the course of COPD accompanies with adverse outcome. These patients have worse spirometry and left ventricle echocardiographic findings, but have no difference in arterial blood gas (ABG) findings.

Incidence Proportion of Acute Cor Pulmonale in Patients with Acute Respiratory Distress Syndrome Subjected to Lung Protective Ventilation: A Systematic Review and Meta-analysis.

Introduction:Reported incidence of acute cor pulmonale (ACP) in patients with acute respiratory distress syndrome (ARDS) varies from 10% to 84%, despite being subjected to lung protective ventilation according to the current guidelines. The objective of this review is to find pooled cumulative incidence of ACP in patients with ARDS undergoing lung protective ventilation.Materials and Methods:We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILACS, and WHO Clinical Trial Registry. Cross-sectional or cohort studies were included if they reported or provided data that could be used to calculate the incidence proportion of ACP. Inverse variance heterogeneity (IVhet) and random effect model were used for the main outcome and measures.Results:We included 16 studies encompassing 1661 patients. The cumulative incidence of ACP using IVhet analysis was 23% (95% confidence interval [CI] = 18%–28%) over 3 days of lung protective ventilation. Random effect analysis of 7 studies (1250 patients) revealed pooled odd ratio of mortality of 1.16 (95% CI = 0.80-1.67, P = 0.44) due to ACP.Conclusion:Patients with ARDS have a 23% risk of developing ACP with lung protective ventilation. Findings of this review indicate the need of updating existing guidelines for ventilating ARDS patients to incorporate right ventricle protective strategy.

Priority Risk Factors of Developing Cor Pulmonale in Patients with Chronic Obstructive Pulmonary Disease According to Correlation Analysis Findings

Priority Risk Factors of Developing Cor Pulmonale in Patients with Chronic Obstructive Pulmonary Disease According to Correlation Analysis Findings

Preventing the development of acute cor pulmonale in patients with acute respiratory distress syndrome: the first step.

Acute respiratory distress syndrome (ARDS) is a clinical condition characterized by acute hypoxemic respiratory failure that is associated with substantial mortality even 40 years since it was first described. Although hypoxemia appears to be the most conspicuous abnormality noticed with this condition, it isn’t the most common cause of death.

Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence

Evidence-based nursing practice is essential to the delivery of high-quality care that optimizes patients' outcomes. Studies continue to show improved outcomes when best evidence is used in the delivery of patient care. Despite awareness of the importance of practicing by using best evidence, achieving and sustaining evidence-based practice within practice environments can be challenging, and research suggests that integration of evidence-based practice into daily clinical practice remains inconsistent. This article addresses 4 practice issues that, first, are within the realm of nursing and if changed might improve care of patients and, second, are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics addressed are (1) noninvasive measurement of blood pressure in children, (2) oxygen administration for patients with chronic obstructive pulmonary disease, (3) intravenous catheter size and blood administration, and (4) infection control practices to prevent infections. The related beliefs, current evidence, and recommendations for practice related to each topic are described.

ECG- and echocardiographic signs of cor pulmonale in patients with chronic obstructive pulmonary disease associated with arterial hypertension

Summary. The objective of the study was to analyze electrocardiographic (ECG) and echocardiographic findings in diagnosis of right heart disease in patients with chronic obstructive pulmonary disease (COPD) including those with concomitant arterial hypertension (AH). ECG and echocardiography were performed in 146 patients with COPD, AH and COPD + AH and in healthy individuals. Routine ECG and echocardiographic examinations of COPD patients found signs of right ventricular hypertrophy in 7.8 % and 72.7 % of patients, respectively. The relative risk of right ventricular hypertrophy in patients with COPD and AH compared to patients with COPD alone was 1.6. In 86.4 % of patients with COPD + AH and cor pulmonale, moderate right ventricular hypertrophy was diagnosed which was associated with dilated right ventricle in several cases.

Analyse du peptide natriurétique de type B comme marqueur du cœur pulmonaire aigu dans le syndrome de détresse respiratoire aiguë

Objective The aim of this study was to evaluate the accuracy of the BNP as a marker of acute cor pulmonale in patients with ARDS. Study design Prospective clinical trial. Patients and methods At day 2 or 3 after the onset of the ARDS, an echocardiography was performed. Patients with left ventricular dysfunction were excluded. Right ventricular area (RVA) and RVA/LVA ratio were measured. ACP was defined as RVA/LVA > 0.6 associated with septal dyskinesia. Simultaneously, 5 ml of blood was collected for BNP measurement. Results 26 patients were studied. BNP levels were higher in 10 patients with ACP: 585.5 [189–4830] vs 145.5 [36.5–346] pg/ml ( P = 0.01) but in those with creatinine clearance < 90 ml/min: 602 [331–3530] vs 125 [39–189] pg/ml ( P = 0.007). BNP was correlated with RVA (r = 0.5; p = 0.01), RVA/LVA ratio (r = 0.61; p = 0.001), sPAP (r = 0.58; p = 0.002) and with age, cardiac index and creatinine clearance (r = 0.61; p = 0.001). In multivariate analysis, BNP was only correlated with creatinine clearance ( p = 0.03), and RVA ( p = 0.06). Conclusion In ARDS patients without left ventricular dysfunction, BNP level is more elevated in patients with acute cor pulmonale than patients without cor pulmonale.

Relationship between hypoxic hepatitis and cor pulmonale in patients treated in the respiratory ICU*

To determine independent risk factors associated with the pathogenesis hypoxic hepatitis (HH) in hypoxemic patients. The prospective study, multivariate analysis, between January 1999 and March 2003 was conducted at University hospital, intensive care unit, Department of Chest Diseases. A total of 445 consecutive patients were included in the study. Patients who were not hypoxemic (PaO(2) > 80 mmHg) were excluded from analysis. The total number of those found eligible for the study was 297. Patients with a >20-fold increase in liver enzyme levels were diagnosed as HH (study group). The other patients were defined as control group. There were no interventions. Mean age was 62, and 191 were males. Twenty-two patients were diagnosed as HH (study group; 7.41%). Cor pulmonale (CP) was 77.3% in the study group and 36.7% in the control group. The need for mechanical ventilation and hospital mortality were 63.6 and 54.5% in the study group and 32 and 28.7% in the control group, respectively. On multivariate analysis, the presence of CP (p = 0.007; OR: 4.418; CI: 1.492-13.083), high-serum BUN level (>37 mg/dl; p = 0.0001; OR: 1.029; CI: 1.015-1.044) and low PaO(2) level (<46 mmHg; p = 0.008; OR: 0.945; CI: 0.906-0.985) were found to be significantly different between the two groups. Patients with severe hypoxemia, CP and higher BUN level have higher risk levels for HH, the most important risk factor being CP.

Doppler Echocardiographic Index of Global Right Ventricular Function

To the Editor: In pulmonary disease, right ventricular dysfunction has an important bearing on prognosis.1 Incalzi et al2 recently demonstrated the prognostic implications of electrocardiographic signs of chronic cor pulmonale in patients with chronic obstructive pulmonary disease. Two electrocardiographic features in particular, an S1S2S3 pattern and a P-wave axis of >90°, suggesting right atrial overload, predicted mortality over 13 years of follow-up. This well-conducted study illustrates the importance of an inexpensive diagnostic technique in risk stratification and is of particular value since the clinical signs of cor pulmonale are too insensitive for routine clinical application. It has been preceded by a …

Elevated plasma brain natriuretic peptide levels in chronic respiratory failure with cor pulmonale

Elevated plasma brain natriuretic peptide (BNP) levels have been described in patients with congestive heart failure and acute myocardial infarction. We measured plasma BNP levels in patients with chronic respiratory failure to evaluate the correlation between plasma BNP levels and pulmonary haemodynamics. Plasma BNP levels were measured in 28 patients with chronic respiratory failure accompanied by three underlying diseases [14 with chronic obstructive pulmonary disease (COPD), seven with sequelae of pulmonary tuberculosis (sequelae Tbc) and seven with diffuse panbronchiolitis (DPB)] by immunoradiometric assay methods (IRMA). Twenty-one of 28 patients had already received oxygen supplementation and 16 of 21 patients were treated as outpatients with home oxygen therapy. Plasma BNP levels were significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (81·5 ± 13·1 pg ml −1) compared to patients without cor pulmonale (13·3 ± 2·7 pg ml −1, P<0·001). As controls, plasma BNP levels in 10 patients with primary lung cancer were studied, and the results (3·5 ± 1·0 pg ml −1) were not significantly different from those of patients with chronic respiratory failure without cor pulmonale. Plasma BNP levels in 12 healthy subjects were also studied, and the results (7·2 ± 1·0 pg ml −1) were not significantly different from those of the control subjects. Plasma BNP levels showed a weak linear correlation with systolic pulmonary arterial blood pressure, estimated by Doppler echocardiography ( r=0·43; P=0·068), but there was no significant correlation between BNP levels and the degree of hypoxaemia ( r=0·30; P=0·138). Plasma atrial natriuretic peptide (ANP) levels in patients with chronic respiratory failure were also measured using the same samples. Plasma ANP levels were also significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (80·8 ± 12·1 pg ml −1) compared to patients without cor pulmonale (26·1 ± 4·4 pg ml −1, P=0·003). A significant correlation was found between plasma BNP and ANP levels ( r=0·68; P<0·001). Our results suggest that the plasma BNP or ANP level may be a useful indicator for detecting the presence of cor pulmonale in patients with chronic respiratory failure.

Effect of L-arginine on renal blood flow in normal subjects and patients with hypoxic chronic obstructive pulmonary disease.

L-arginine is the precursor of endothelium derived nitric oxide (NO) and increasing the available substrate may increase the production of NO. This has been shown by local infusion in peripheral vascular beds but there are few studies of the effects during systemic infusion. Renal vasoconstriction is known to be important in the pathogenesis of cor pulmonale in patients with hypoxic chronic obstructive pulmonary disease (COPD). The effects of a systemic infusion of L-arginine on renal and aortic haemodynamics were therefore investigated in normal subjects and in patients with hypoxic COPD. Ten normal volunteers were recruited from the research staff of King's College Hospital Six patients with COPD and hypoxia (arterial oxygen tension (PaO2) < 8.5 kPa) were recruited from the thoracic medicine outpatient clinic at King's College Hospital and five age and sex matched normal subjects were recruited from a group of normal subjects recruited from the database of the Department of Health Care for the Elderly as volunteers for medical research. There was no history of renal, cardiac, or hepatic disease. Baseline values of time averaged mean of the maximum instantaneous velocity (Tamx) and maximum velocity (Vmax) of blood flow in intrarenal arteries were obtained using colour flow Doppler ultrasound. Using the same technique, Vmax was obtained from the abdominal aorta just distal to the xiphisternum before and after infusion of L-arginine via a large peripheral vein (20 g in 100 ml sterile water over 30 minutes). In normal subjects L-arginine increased blood velocity in the intrarenal vessels from a mean of 0.22 m/s to 0.26 m/s, an increase of 19.8%. There was no effect on arterial blood pressure, heart rate, or aortic blood velocity. L-arginine had no effect on intrarenal or aortic blood velocity in patients with hypoxic COPD. In age matched controls L-arginine increased blood velocity in the intrarenal vessels from a mean of 0.20 m/s to 0.26 m/s, an increase of 36.8%. There was no effect on arterial blood pressure, heart rate, or aortic blood velocity. L-arginine, at the doses administered, increased renal blood flow, as assessed by renal arterial velocity. This effect was not seen in patients with hypoxic COPD but was present in age matched controls. This suggests that the abnormal renal vascular control seen in hypoxic patients with COPD may reflect a disturbance of the L-arginine/nitric oxide pathway.

Oral almitrine in treatment of acute respiratory failure and cor pulmonale in patients with an exacerbation of chronic obstructive airways disease.

The effects of oral almitrine bismesylate, a respiratory stimulant that acts on peripheral arterial chemoreceptors, was studied in patients with chronic obstructive airways disease and hypoxaemic cor pulmonale. Twenty three patients admitted to hospital with an acute exacerbation of ventilatory failure were randomised to receive either almitrine 100 mg twice a day reducing to 50 mg twice a day over 48 hours or placebo in addition to conventional treatment. On admission the mean (SE) values for blood gas tensions were PaO2 4.8 (0.3) and PaCO2 7.7 (0.3) kPa in the 12 patients who received almitrine and PaO2 4.9 (0.1) and PaCO2 7.6 (0.3) kPa in the 11 who received placebo. After three hours of oxygen therapy at 1 1/min there was a similar rise in PaO2 in both groups, 6.4 (0.2) kPa in those receiving almitrine and 6.6 (0.4) kPa in those receiving placebo. After 24 hours of oxygen therapy values of PaO2 were again similar at 6.3 (0.8) kPa and 6.7 (2.2) kPa respectively. Arterial blood gas tensions improved during the study in those who survived but no significant differences were apparent between the two groups. There were six deaths, five in the almitrine group and one in the placebo group. There were no differences between the groups in respiratory rate, results of spirometry, oxygen requirement, or degree of dyspnoea (on visual analogue scale). The results did not show any benefit from oral almitrine in patients with acute respiratory failure secondary to chronic obstructive airways disease. Plasma almitrine concentrations, however, were often below the optimum therapeutic range, suggesting impaired drug absorption.

Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease*: Evaluation and Management

Cor pulmonale is an important consequence of COPD. Although the incidence is not precisely known, it is seen more frequently in patients with hypoxemia, CO2 retention and severely reduced FEV1. When present, it limits peripheral oxygen delivery, increases shortness of breath, and reduces exercise endurance. It is also associated with higher mortality rates independent of other prognostic variables. Numerous factors may contribute to the development of cor pulmonale in patients with COPD, but its primary cause is chronic alveolar hypoxia resulting in pulmonary vasoconstriction, vascular remodeling and pulmonary hypertension. The physical exam, chest radiograph and ECG may be helpful in detecting the presence of cor pulmonale, but because of anatomic changes that occur in the chest, these tests are often insensitive in patients with COPD. Noninvasive diagnostic techniques utilizing Doppler echocardiography and radionuclide angiography allow for detection of RV dysfunction at an earlier stage and in most cases, preclude the need for right heart catheterization. LTO2 is the only therapy shown to improve survival in patients with COPD. However, statistical proof correlating improvements in pulmonary hemodynamics with increased survival is lacking. Bronchodilators, such as the beta 2 agonists and especially theophylline, may have beneficial effects on pulmonary hemodynamics in addition to their effect on respiratory function and are useful in COPD when RV dysfunction is present. Diuretics and phlebotomy are also useful in improving symptoms in appropriate patients. Vasodilators such as calcium channel blockers and ACE-inhibitors may improve pulmonary hemodynamics acutely, but may lower arterial PO2 by worsening ventilation-perfusion matching or blunt the improvement in pulmonary hemodynamics seen with supplemental oxygen. The long-term benefits of these agents have not been proven and their routine use in patients with cor pulmonale due to COPD cannot be recommended.

Long-Term Oxygen Therapy for Cor Pulmonale in Patients with Chronic Obstructive Pulmonary Disease

Besides smoking cessation, antiobstructive therapy, and the treatment of intercurrent infections, long-term oxygen therapy has had the most impressive impact on survival in patients with chronic obstructive pulmonary disease (COPD). COPD leads to a functional and anatomical obstruction of the pulmonary vascular bed, with the development of pulmonary arterial hypertension and cor pulmonale. In these patients, survival benefit from long-term oxygen therapy (LTOT) stems mainly from improved hemodynamics. However, this improvement is limited: hypoxemic COPD patients treated by LTOT have the same life expectancy as nonhypoxemic COPD patients. Practical aspects concerning the prescription and application of LTOT are discussed, with special emphasis on ambulatory oxygen and oxygen-saving techniques.

Improved recognition of cor pulmonale in patients with severe chronic obstructive pulmonary disease

To compare sensitivity of clinical methods (physical examination, electrocardiogram, and chest radiograph) to echocardiography in the detection of cor pulmonale, and to determine the role of nocturnal oxygen desaturation in its development, 33 non-hypoxemic patients who had severe chronic obstructive pulmonary disease (COPD) were evaluated by clinical methods, echocardiography, and overnight ear oximetry. Compared to 25 age-matched control subjects, COPD patients had higher peak pulmonary systolic pressures by contrast-enhanced Doppler (40 ± 13 versus 22 ± 5 mm Hg, or 5.3 ± 1.7 versus 2.9 ± 0.7 kPa) and ratios of right to left ventricular volume (1.1 ± 0.6 versus 0.6 ± 0.1, both p <0.05). Defining cor pulmonale as pulmonary hypertension, right ventricular enlargement, or right ventricular hypertrophy, 25 COPD patients (75 percent) had cor pulmonale by echocardiography and 13 (39 percent) by clinical methods (p <0.05). Nocturnal desaturation was present in only 21 percent of patients. Echocardiographic measurements were similar between patients with emphysema and patients with bronchitis, and between patients with and without sleep desaturation. In patients who have severe COPD without waking hypoxemia, cor pulmonale is detected nearly twice as often by echocardiography as by clinical methods, but is usually not associated with sleep desaturation.