Pulmonary Hypertension In COPD Patients Research Articles

Correlation between presence of nocturnal oxygen desaturation with pulmonary hypertension

Aim of the study: To study presence of nocturnal oxygen desaturation with pulmonary hypertension. Results: The mean age of patients was 69.51 years. The mean duration of COPD was 4.14 years. The mean smoking index of study population was 401.32. Mean baseline SPO2. The mean BMI was 26.32 kg/m2. The mean hemoglobin level was 11.21 g/dL. The partial pressure of oxygen and carbon dioxide in desaturators and nondesaturators was 61.54 mmHg and 70.65 mmHg respectively. The presence of nocturnal hypoxemia has been postulated as the etiopathological factor resulting in the development of pulmonary hypertension in COPD patients. Conclusion: From the results of the present study, this can be concluded that 29 % of the normoxemic patients had significant nocturnal desaturation. The significant predictors of nocturnal desaturation are PaO2 and PaCO2.

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CHRONIC LUNG DISEASE AND ITS PROGRESSION TO PULMONARY HYPERTENSION: THE NEED FOR EARLY SCREENING

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Despite the evolution of group 3 pulmonary hypertension (PH) management and treatment, reports suggest that over half of patients are diagnosed with PH at an advanced stage (1). Factors such as the presence of nonspecific symptoms, over-reliance on echocardiography, and decreased use of right-heart-catheterization (RHC) contribute to delayed diagnosis (2). We present this case to highlight the importance of early diagnosis of PH due to chronic lung disease. CASE PRESENTATION: A 60-year-old African-American female with a past-medical-history of chronic obstructive pulmonary disease on 3L home oxygen (GOLD stage 4), secondary erythrocytosis, and obstructive sleep apnea presented with bilateral leg pain and subjective fevers. Vitals were significant for hypotension (BP 96/51) and tachycardia (HR 106). Physical exam revealed an obese female in moderate distress with 2+bilateral lower extremity edema with diffuse, erythematous, and purulent rashes in the same areas. Labs were significant for elevations in lactic acid (2.7), bicarbonate (39), and hemoglobin/hematocrit (15.3/51.7). Chest x-ray (CXR) showed cardiomegaly. EKG showed normal sinus rhythm without any ischemic findings. The patient was started on broad spectrum antibiotics and IV fluid resuscitation for sepsis secondary to cellulitis. On hospital day 4, the patient developed acute respiratory distress with desaturation to 85%. Arterial blood gases showed pH 7.26, pO2, 69, pCO2 68, consistent with hypercarbic respiratory failure. Repeat CXR revealed interval development of a large right pleural effusion. Emergent thoracentesis was performed with 600cc of fluid with labs consistent for transudative effusion (serum/pleural: LDH 227/59, protein 5.5/2). Echocardiograph revealed normal ejection fraction and left ventricular function, but an elevated right ventricular systolic pressure (50-60mmhg) and a flattened septum. RHC was performed and revealed fixed severe pulmonary hypertension with negative vasoreactivity (PA:59mmhg, RA:33mmhg, PAVR:7) The patient was started on non-invasive ventilatory support in addition to aggressive diuresis given negative vasoreactivity on RHC. However, her respiratory status continued to deteriorate despite sepsis resolution. After further discussion with the patient, she decided to transition to comfort measures with subsequent transfer to a hospice facility DISCUSSION: PH associated with chronic lung diseases confers poor prognosis. Despite a high prevalence (62.4%) of PH in COPD patients (3), there are no PH screening guidelines in this high-risk patient population. CONCLUSIONS: The establishment of early screening methods prior to the progression of pulmonary vascular dysfunction to PH will ultimately decrease the disease progression, reduce mortality, and improve quality of life in this high-risk population. Reference #1: Ginoux M, Turquier S, Chebib N, et al. Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension. ERJ Open Res. 2018;4(4):00100-2018. Published 2018 Nov 28. https://doi.org/10.1183/23120541.00100-2018 Reference #2: Maron BA, Galiè N. Diagnosis, Treatment, and Clinical Management of Pulmonary Arterial Hypertension in the Contemporary Era: A Review. JAMA Cardiol. 2016;1(9):1056–1065. https://doi.org/10.1001/jamacardio.2016.4471 Reference #3: Gupta KK, Roy B, Chaudhary SC, et al. Prevalence of pulmonary artery hypertension in patients of chronic obstructive pulmonary disease and its correlation with stages of chronic obstructive pulmonary disease, exercising capacity, and quality of life. J Family Med Prim Care. 2018;7(1):53-57. DISCLOSURES: No relevant relationships by Temidayo Abe, source=Web Response No relevant relationships by Philip Bene, source=Web Response No relevant relationships by Eric Chang, source=Web Response No relevant relationships by Gabrielle De Allie, source=Web Response No relevant relationships by Parris Tanksley, source=Web Response

CATEGORIZATION OF GROUP 3 PULMONARY HYPERTENSION BY THE 2018 DEFINITION: WHO IS IN, WHO IS OUT?

SESSION TITLE: Pulmonary Hypertension: Characteristics and Treatment SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: The definition of pulmonary hypertension (PH) was modified at the 6th World Symposium in 2018. Our objective was to evaluate the 2013 vs 2018 definitions of PH and determine the prevalence and crossover between categories by both definitions. METHODS: The Inova Fairfax Advanced Lung Disease Database was queried for COPD and ILD patients who were evaluated with right heart catheterizations (RHC) between 2000 and 2018. RHC data was extracted along with age, gender and PFTs. PH by the old definition (mPAP 20 mmHg, PAWP ≤ 15 mmHg, PVR ≥ 3 WU), Isolated Post-Capillary PH (mPAP > 20 mmHg, PAWP > 15 mmHg, PVR < 3 WU), and Combined Pre- & Post-Capillary PH (mPAP > 20 mmHg, PAWP > 15 mmHg, PVR ≥ 3 WU). The COPD and ILD subgroups were analyzed independently. RESULTS: A total of 202 COPD and 276 ILD patients met the inclusion criteria. The prevalence of PH by the old vs new definition was 61.4%/64.4% for COPD and 53.6%/51.1% for ILD. Crossover from the traditional 2 categories of PH into the 4 new categories as well as their prevalence are as follows: 11.3% of COPD patients and 14.9% of ILD patients who qualified as having PH by the old definition, crossed over into the No-PH category by the new definition. Conversely, 25.7% of COPD and 11.7% of ILD patients previously categorized as no PH now qualified as having PH. Breakdown of prevalence by 4 new groups of PH in COPD patients was the following: 35.6%, 42.1%, 10.4%, and 11.9% for No-PH, Pre-Cap PH, Post-Cap PH, and PrePost-Cap PH, respectively. For the ILD patients, 4 groups of PH shared prevalence at 48.9%, 37.7%, 8.7%, and 4.7%, respectively. CONCLUSIONS: Although the prevalence of PH was very similar between the 2 definitions, the patients who comprised these groups were very different. Which of the definitions performs best in discerning outcomes remains to be determined. CLINICAL IMPLICATIONS: N/A DISCLOSURES: No relevant relationships by Scott Barnett, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 Added 03/08/2019 by Christopher King, source=Web Response, value=Honoraria No relevant relationships by Inga Ksovreli, source=Web Response Consultant relationship with Roche-Genentech Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with United Therapeutics Please note: $1001 - $5000 Added 11/25/2018 by Oksana Shlobin, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Bayer Please note: $1001 - $5000 Added 11/25/2018 by Oksana Shlobin, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Johnson & Johnson Please note: $1001 - $5000 Added 11/25/2018 by Oksana Shlobin, source=Web Response, value=Honoraria

A cross sectional study of clinical profile and evaluation of pulmonary hypertension in Chronic Obstructive Pulmonary Disease patients in a tertiary care hospital of Mangalore, India

Background: The objectives was to study the clinical profile of COPD patients and to evaluate pulmonary hypertension in COPD patients by non-invasive methods.Methods: A prospective observational study of patients who satisfy all inclusion and exclusion criteria in OPD or admitted in medical wards of AJIMS Mangalore. The study was conducted from October 2017 to October 2018 with the sample size of 90 subjectsResults: Out of 90 subjects 53 (58.8%) of them had pulmonary hypertension. Among the subjects who had pulmonary hypertension 29 (54.72%) of them had moderate pulmonary hypertension, 17 (32.08%) of them had severe pulmonary hypertension and 7 (13.20%) of them had mild pulmonary hypertension. Mean age among the subjects who had pulmonary hypertension was 64.24+7.62yrs and mean age among the subjects who didn’t had pulmonary hypertension was 51.87+8.97yrs. There was a statistically significant difference found between mean age and pulmonary hypertension. Mean duration of diseases among the subjects who had pulmonary hypertension was 8.13+1.74yrs and Mean duration of diseases among the subjects who didn’t had pulmonary hypertension was 5.36+1.98yrs. There was a statistically significant difference found between mean duration of disease and pulmonary hypertension.Conclusions: Due to high prevalence of pulmonary hypertension we suggest screening for the all COPD patients for cardiac complications. This will help in identifying the individual who requires close monitoring and also in reducing the mortality.

Cardiopulmonary exercise test and PaO2 in evaluation of pulmonary hypertension in COPD.

BackgroundExercise tolerance decreases as COPD progresses. Pulmonary hypertension (PH) is common in COPD and may reduce performance further. COPD patients with and without PH could potentially be identified by cardiopulmonary exercise test (CPET). However, results from previous studies are diverging, and a unified conclusion is missing. We hypothesized that CPET combined with arterial blood gases is useful to discriminate between COPD outpatients with and without PH.MethodsIn total, 93 COPD patients were prospectively included. Pulmonary function tests, right heart catheterization, and CPET with blood gases were performed. The patients were divided, by mean pulmonary artery pressure, into COPD-noPH (<25 mmHg) and COPD-PH (≥25 mmHg) groups. Linear mixed models (LMMs) were fitted to estimate differences when repeated measurements during the course of exercise were considered and adjusted for gender, age, and airway obstruction.ResultsVentilatory and/or hypoxemic limitation was the dominant cause of exercise termination. In LMM analyses, significant differences between COPD-noPH and COPD-PH were observed for PaO2, SaO2, PaCO2, ventilation, respiratory frequency, and heart rate. PaO2 <61 mmHg (8.1 kPa) during unloaded pedaling, the only load level achieved by all the patients, predicted PH with a sensitivity of 86% and a specificity of 78%.ConclusionDuring CPET, low exercise performance and PaO2 strongly indicated PH in COPD patients.

Usefulness of the desaturation-distance ratio from the six-minute walk test for patients with COPD.

PurposeA straightforward, noninvasive method is needed to assess emphysema and pulmonary hypertension (PH) in COPD patients. The desaturation–distance ratio (DDR) is an index derived from the distance traveled and level of desaturation during a six-minute walk test (6MWT); it has previously been shown to be associated with percentage of forced expiratory volume in the first second of expiration (%FEV1.0) and percentage of diffusion capacity of the lung for carbon monoxide (%DLCO). The aim of this study was to examine the associations between DDR and emphysema and PH.Patients and methodsWe collected the following data for 74 stable COPD outpatients: lung function tests (%FEV1.0 and %DLCO), 6MWT distance and desaturation, and area of emphysema on computed tomography (percentage of low attenuation area). Enlargement of the pulmonary artery (PA) was assessed by the ratio of the diameter of the PA to that of the aorta (PA:A ratio) as an index of PH. DDR was calculated by the distance traveled and the degree of desaturation reached during a 6MWT. The relationships between study outcomes were assessed with Spearman’s rank-correlation analysis. Receiver operating characteristic (ROC) curves were used to determine the threshold values with the optimum cutoff points for predicting severe or very severe airway obstruction, pulmonary diffusing capacity disorder, moderate or severe emphysema, and enlargement of the PA.ResultsDDR correlated significantly with %FEV1.0, %DLCO, %LAA, and PA:A ratio. DDR showed high accuracy (area under the ROC curve >0.7) for predicting severe or very severe airway obstruction, pulmonary diffusing capacity disorder, moderate or severe emphysema, and enlargement of the PA.ConclusionThe results suggest that DDR is a good index of emphysema and PH in COPD patients. The 6MWT is widely used to assess COPD, and DDR could help with the early diagnosis of COPD.

The Use of Macitentan in the Treatment of Out-of-Proportion Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease: Case Report

Pulmonary hypertension (PH) is an important complication of chronic pulmonary disease, especially of chronic obstructive lung disease (COPD). The exact prevalence of PH in COPD is unknown. PH is defined as an increase in mean pulmonary arterial pressure (PAPm) > 25 mmHg at rest as assessed by right heart catheterization . In most cases, PH in COPD patients is usually mild to moderate.

Exercise hypoxaemia as a predictor of pulmonary hypertension in COPD patients without severe resting hypoxaemia.

Pulmonary hypertension (PH) in COPD is associated with morbidity and mortality. Previous studies showed a relationship between resting hypoxaemia and PH, but little is known about the relationship between exercise hypoxaemia and PH in COPD without resting hypoxaemia. A retrospective observational study of COPD patients without resting hypoxaemia was conducted to evaluate the relationships between exercise hypoxaemia and pulmonary haemodynamics. Clinical characteristics, pulmonary function, blood gas analysis, 6-min walk distance (6MWD) and oxygen saturation of peripheral artery (SpO2 ) at the end of the 6-min walk test (6MWT) were reviewed. Correlation analysis and stepwise regression analysis were performed to identify the predictor of mean pulmonary artery pressure (mPAP). Eighty-four consecutive patients with a mean predicted forced expiratory volume in 1 s (FEV1 ) of 47 ± 21% were evaluated. In univariate analysis, mPAP had negative correlations with age (r = -0.27, P < 0.05), arterial partial pressure of oxygen (PaO2 , r = -0.24, P < 0.05), % predicted forced vital capacity (FVC, r = -0.28, P < 0.05), % predicted FEV1 (r = -0.40, P < 0.001), FEV1 /FVC ratio (r = -0.33, P < 0.005), % predicted diffusion capacity for carbon monoxide (DLCO , r = -0.40, P < 0.001), 6MWD (r = -0.40, P < 0.001) and SpO2 at the end of the 6MWT (r = -0.74, P < 0.001). In stepwise regression analysis, SpO2 at the end of the 6MWT and 6MWD remained as independent predictors of mPAP (R2 = 0.60). In receiver operating characteristic (ROC) analysis, SpO2 at the end of the 6MWT presented an area under the curve of 0.896 for the prediction of PH, with a sensitivity of 0.86 and specificity of 0.84 for the cut-off point of 81%. In addition to 6MWD, exercise hypoxaemia indicates PH in patients with COPD without resting hypoxaemia.

Prevalence of Pulmonary Hypertension in COPD Patients: A Retrospective Observational Study

Prevalence of Pulmonary Hypertension in COPD Patients: A Retrospective Observational Study

Detection of right sided heart changes and pulmonary hypertension in COPD patients

RationaleAssessing the function of the right side of the heart along with diagnosing of pulmonary hypertension and studying the hemodynamic abnormalities, thus studying functional limitations of pulmonary hypertension on COPD patients. MethodsData from 51 COPD male patients between December 2012 and April 2013 were reviewed. PFTs (post bronchodilators FEV1⩽0.7), echo, BODE index were obtained, RHC was done only for 17 patients after their echo revealed PASP⩾45mmHg. ResultsWe found 11 patients (21.5%) had MPAP⩾25mmHg by RHC (35.27±7.837) and 2 patients (∼4%) had severe PH (MPAP⩾40mmHg). The mean age 62 (±9.16) with smoking index 34 (±6.5). 63% of the patients had PASP⩾35mmHg by echocardiography while 24 patients (47%) had PASP⩾45mmHg. COPD patients with PH were more hypoxemic (53.73±6.214 vs. 62.51±10.999, p-value 0.00013), showed increased BODE index (8.45±1.572 vs. 6.31±2.604, p-value 0.0015), showed statistically significant difference in both BRV and LRV (3.725±0.8625 vs. 4.500±0.9849 p-value 0.0304 and 6.067±0.9923 vs. 6.927±0.7888, 0.006 respectively), showed a significant difference in the measurement of TAPSE (2.055±0.5298, 3.142±0.3437 with p-value <0.0001) as compared to COPD patients without PH linear correlation between PaO2 and BODE index with MPAP was noticed. 41 patients (80%) had LT E/A ratio less than 0.8 with statistically significant difference between COPD patients with PH and those without (0.518±0.1991, 0.702±0.4052 and p-value 0.0333). We found that echo (1) sensitivity was about 65%, specificity of 50% with positive predictive value around 64% and negative predictive value around 50% (2) 74% of the patients had >10mmHg difference between PASP calculated by echo and measured by RHC. ConclusionWe conclude that PH in COPD patients is a common co-morbidity along with right sided changes. Echo could be used with caution during assessment of PASP as it was inaccurate. COPDPH patients had worse prognosis than COPD patients without PH. Clinical impactScreening for PH in any COPD is highly recommended as it affects the prognosis.Echo could be used with caution during assessment of PASP in these patients.

Pulmonary artery size as a predictor of pulmonary hypertension and outcomes in patients with chronic obstructive pulmonary disease

The relationship between pulmonary artery size with underlying pulmonary hypertension and mortality remains to be determined in COPD. We sought to evaluate the relationships in a cohort of patients with advanced COPD. A retrospective study of advanced COPD patients evaluated between 1998 and 2012 was conducted at a tertiary care center. Patients with chest computed tomography images and right heart catheterizations formed the study cohort. The diameters of the pulmonary artery and ascending aorta were measured by independent observers and compared to pulmonary artery pressures. Intermediate-term mortality was evaluated for the 24-month period subsequent to the respective studies. Cox proportional hazards model was used to determine independent effects of variables on survival. There were 65 subjects identified, of whom 38 (58%) had pulmonary hypertension. Patients with and without pulmonary hypertension had mean pulmonary artery diameters of 34.4 mm and 29.1 mm, respectively (p = 0.0003). The mean PA:A ratio for those with and without pulmonary hypertension was 1.05 and 0.87, respectively (p = 0.0003). The PA:A ratio was an independent predictor of mortality with a reduced survival in those with a PA:A >1 (p = 0.008). The PA:A ratio is associated with underlying pulmonary hypertension in patients with COPD and is an independent predictor of mortality. This readily available measurement may be a valuable non-invasive screening tool for underlying pulmonary hypertension in COPD patients and appears to impart important independent prognostic information.

Investigation on irbesartan combined with low molecular weight heparin in the treatment of COPD patients with pulmonary hypertension

Objective To evaluate the clinical effect,the changes of pulmonary hypertension,serum D-dimer and side effect of irbesartan combined with low molecular weight heparin in the treatment of pulmonary hypertension in COPD patients.Methods 49 patients of COPD were randomly allocated into two groups:the control group( n =22 )and the treatment group( n =27).The patients of the control group were treated with common treatments,for the treatment group,irbesartan 80mg qd combined with low molecular weight heparin 0.4ml IH bid were additionally administered for 14 days.To evaluate the clinical effect,the changes of pulmonary hypertension,serum D-dimer and side effects.Results The treatment group and the control group could reduce the pulmonary artery pressure.The clinical effects of the former were statistically significant better than the control(P ＜0.01 ).Side effect had no statistically significant difference between two groups.Conclusion Irbesartan combined with low molecular weight heparin have better clinical effects in the treatment of pulmonary hypertension in COPD patients and it was convenient,safe and worthy of extending in clinic. Key words: Irbesartan; Low molecular weight heparin; Pulmonary hypertension

Echocardiographic screening for pulmonary hypertension in COPD patients

Echocardiographic screening for pulmonary hypertension in COPD patients

Pathogenesis of Chronic &#x201C;Cor pulmonale&#x201D; in COPD

Although “cor pulmonale” represents a leading cause of death in advanced COPD, there is no clear consensus on its definition. Pulmonary hypertension has been traditionally considered the pathogenetic mechanism leading to right heart dysfunction in COPD, with peripheral oedema usually being attributed to the venous congestion secondary to the increase of right-ventricle filling pressure. The loss in pulmonary capillaries and the vascular remodelling, secondary to chronic hypoxia, cigarette-smoke exposition and systemic inflammation, are well known causes of endothelial dysfunction and pulmonary hypertension in COPD patients. Other mechanisms, such as hypoxic vasoconstriction and alveolar capillary compression in hyperinflated lungs can contribute to the rise of pulmonary arterial pressure during COPD exacerbations, exercise and sleep. In the last decades, however, the role of pulmonary pressure overload in the development of right heart failure has been debated mostly, because of the lack of a clear correlation between pulmonary artery pressure values and the presence of peripheral oedema and/or haemodynamic signs of right heart failure. In addition, the presence of distinct renal and hormonal alterations, suggests that oedema formation in advanced phases of COPD is mostly due to sodium and water retention induced by hypercapnic acidosis and aggravated by severe hypoxemia. Future studies are needed to clarify the possible role of “intermittent hypoxia”, elicited by exercise or sleep, on right heart function and also on sodium and water handling in COPD patients. Keywords: Pulmonary hypertension, vascular remodelling, lung hyperinflation, right heart dysfunction

A study of correlation between transhilar diameter and p pulmonale in copd patients.

Background:Early diagnosis and therapy of Pulmonary hypertension in COPD patients may help in retardation of progression and amelioration of symptoms. This is an attempt to diagnose the disease from X-ray chest of COPD patients, so that invasive investigations can be avoided. Objectives:(1) Measurement of transhilar diameter in Chest X-ray PA view of COPD patients and its importance in detection of pulmonary hyper-tension. (2) To study correlation between P pulmonale and transhilar diameter / hilar thoracic ratio.Design:Prospective Clinical study.Setting:Institute of Chest Diseases, Medical College, Calicut.Period of study:One year from September 2002 to August 2003. Materials and Methods:100 patients admitted to Institute of Chest Diseases with COPD and ECG evidence of P pulmonale and/or RVH were included. Chest X-rays was taken and the following diameters were measured. Transhilar diameter, hilar thoracic ratio, width of descending branch of (Rt) pulmonary artery and cardiothoracic ratio.Conclusions:Chest X-ray can be used for identification of pulmonary hypertension in COPD patients. Positive correlation was seen between P pulmonale and hilar thoracic ratio. Positive correlation was also seen between P pulmonale and other parameters like smoking status, symptom duration, ECG evidence of RVH and negative correlation was seen with % predicted FEV1.

Correlation Between NT-proBNP and Pulmonary Arterial Pressure in COPD Patients

Background: Pulmonary hypertension is one of the cardiovascular complications of in COPD. However, a diagnosis of pulmonary hypertension requires an invasive test, such as right heart catheterization. NT-proBNP is a cardiac hormone that is elevated when a cardiac volume or pressure overload is present. It was hypothesized that NT-proBNP might play a role in detecting of pulmonary hypertension in COPD patients. Method: The 31 COPD patients, who underwent all of NT-proBNP, echocardiography, and spirometry in Seoul National University Bundang Hospital during the period from November 2003 to July 2005, were retrospectively analyzed. Result: Of the 31 COPD patients, 9 patients had pulmonary hypertension. A significant positive correlation was observed between the NT-proBNP and pulmonary arterial pressure (r=0.589, p=0.002). However, there was no significant correlation observed between the and NT-proBNP and and pulmonary arterial pressure. Conclusion: NT-proBNP might indicate the presence of pulmonary hypertension in COPD patients.

Systemic Inflammation in Patients With COPD and Pulmonary Hypertension

COPD is a systemic disorder that is associated with increases of inflammatory proteins in systemic circulation. However, no data on the potential role of systemic inflammation in pulmonary hypertension secondary to COPD are available. Therefore, our aim was to investigate the degree of systemic inflammation reflected by circulatory levels of C-reactive protein (CRP), tumor-necrosis factor (TNF)-alpha, and interleukin (IL)-6 in COPD patients with and without pulmonary hypertension. Cross-sectional study. University hospital, tertiary referral setting. In 43 consecutive patients with COPD (mean [+/- SD] age, 65.0 +/- 10.5 years; mean FEV(1), 46.2 +/- 18.1% predicted), lung function was assessed using body plethysmography; pulmonary artery pressure (Ppa) levels were measured by echocardiography. Serum TNF-alpha and IL-6 levels were assessed by enzyme-linked immunosorbent assay, and high-sensitivity serum CRP levels were measured by chemiluminescent immunoassay. Pulmonary hypertension was present in 19 patients and was absent in 24 patients. In patients with pulmonary hypertension, serum CRP and TNF-alpha levels were significantly higher than in those patients without hypertension (median, 3.6 mg/L [25th to 75th percentile, 1.4 to 13.0 mg/L] vs 1.8 mg/L [25th to 75th percentile, 0.8 to 2.8 mg/L; p = 0.034]; and median, 4.2 pg/mL [25th to 75th percentile, 3.4 to 10.9 pg/mL] vs 3.1 pg/mL [25th to 75th percentile, 2.1 to 4.2 pg/mL]; p = 0.042, respectively). No differences were seen in serum IL-6 (median, 10.4 pg/mL [25th to 75th percentile, 8.8 to 12.2 pg/mL] vs 10.5 pg/mL [25th to 75th percentile, 9.4 to 39.1 pg/mL]; p = 0.651) between the groups. In multiple linear regression analysis, the following two variables were independent predictors of systolic Ppa (R(2) = 0.373): Pao(2) (p = 0.011); and log-transformed serum CRP level (p = 0.044). We conclude that increases in Ppa in patients with COPD are associated with higher serum levels of CRP and TNF-alpha, raising the possibility of a pathogenetic role for low-grade systemic inflammation in the pathogenesis of pulmonary hypertension in COPD patients.

Alteration of Coagulation and Fibrinolysis System According to Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease

Background: Pulmonary hypertension in COPD patients is the result of a direct effect of tobacco smoke on the intrapulmonary vessels with the abnormal production of the mediators that control vasoconstriction, vasodilatation, and vascular cell proliferation, which ultimately lead to aberrant vascular remodeling and physiology. COPD patients are prone to the developmint of an acute and chronic thromboembolism with an elevation of the plasma procoagulant and fibrinolytic markers However, the roles of the coagulation and fibrinolysis system on the right ventricular dysfunction in COPD patients are not well defined. We examined the alteration of the coagulation and fibrinolysis system in COPD patients according to the right ventricular function measured using cardiac multidetector computed tomography (MDCT). Methods: The right ventricular ejection fraction (RVEF) was measured using cardiac MDCT in 26 patients who were diagnosed with COPD according to the definition of the GOLD guideline. The plasma level of thrombin antithrombin (TAT) and plasminogen activator inhibitor (PAI)-1 were measured using an enzyme linked immunoassay. Results: The plasma TAT was markedly elevated in COPD patients () compared with those of the control () (p) was similar to that in the controls. The plasma TAT showed a significant inverse relationship with the RVEF measured by the cardiac MDCT in COPD patients (r=-0.645, p