Theme: advanced lung disease
Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease

https://doi.org/10.1016/j.healun.2011.11.020Get rights and content

Background

The prevalence, prognostic importance, and factors that predict the presence and degree of pulmonary hypertension (PH) diagnosed with right heart catheterization (RHC) in patients with end-stage chronic obstructive pulmonary disease (COPD) remain unclear.

Methods

This retrospective study included 409 patients (61% women) with COPD/emphysema or α-1-antitrypsin deficiency who underwent lung transplant evaluation during 1991 to 2010. We analyzed the occurrence and degree of PH and compared demographics, oxygenation, lung function, hemodynamics, functional capacity, and survival in patients with and without PH. Prediction of PH was assessed using univariate and multivariate regression analysis.

Results

The mean age at evaluation was 54 ± 7 years. All patients were in New York Heart Association functional class III-IV, with forced expiratory volume in 1 second of 23% ± 7% and total lung capacity of 126% ± 21% of predicted. PH was present in 146 (36%). The analysis excluded 53 (13%) with pulmonary venous hypertension (PVH). The distribution of the mean pulmonary artery pressure (mPAP) in patients with or without PH showed a unimodal normally distributed population, with a mean of 23.8 ± 6.0 mm Hg. Predictors of PH were partial pressures of oxygen and carbon dioxide. The 5-year survival rate was 37% in COPD patients with PH vs 63% in patients without PH (p = 0.016). Survival after lung transplantation did not differ (p = 0.37).

Conclusions

RHC verified PH in 36% of COPD patients. Hypoxemia and hypercapnia were associated with mPAP. PH is associated with worse survival in COPD, but PH does not influence the prognosis after lung transplantation.

Section snippets

Study population

This was a retrospective study of a consecutive cohort of COPD/emphysema and α-1-antitrypsin–deficient patients who underwent evaluation for lung transplantation at the National University Hospital, Rigshospitalet, Denmark, from January 1991 to January 2010. Patients were primarily identified from the ScandiaTransplant Registry, a Nordic registry that lists patients for transplantation. The study also included patients who had been evaluated but not listed for lung transplantation.

The

Results

Of 562 potential candidates for inclusion, 65 were excluded: 16 because of concomitant pulmonary fibrotic restrictive diseases, 41 because of absence of the entire pre-transplant evaluation data set and 8 due to various other reasons, leaving 497 patients eligible for inclusion. A further 88 patients were excluded due to the absence of RHC data, resulting in a study population of 409 patients (Figure 1). Of these, 277 patients (68%) underwent lung transplantation, and 132 (32%) were evaluated

Discussion

The present study identified PH in 36% of patients with end-stage COPD who were evaluated for pulmonary transplantation. Hypoxemia and hypercapnia were identified as significant predictors of mPAP, whereas demographics, lung function, and functional parameters showed no relation to pulmonary pressures. PH in end-stage COPD was associated with increased mortality, but does not influence the prognosis after lung transplantation.

Disclosure statement

The study received grant support from the Jacob & Olga Madsens Foundation and the Heart-Center Research Foundation, Copenhagen, Denmark.

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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