1
|
Bunel V, Guyard A, Dauriat G, Danel C, Montani D, Gauvain C, Thabut G, Humbert M, Castier Y, Dorfmüller P, Mal H. Pulmonary Arterial Histologic Lesions in Patients With COPD With Severe Pulmonary Hypertension. Chest 2019; 156:33-44. [PMID: 30872017 DOI: 10.1016/j.chest.2019.02.333] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/18/2019] [Accepted: 02/01/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The development of pulmonary hypertension (PH) during the course of COPD is a well-known phenomenon, with the prevalence depending on the severity of airway obstruction. When mean pulmonary pressure (mPAP) level at rest is ≥ 35 mm Hg or ≥ 25 mm Hg with low cardiac index, the term severe PH is used. For these patients, little is known on the underlying histologic lesions. Our objective was to describe these lesions. METHODS From the explants of patients undergoing lung transplantation, we compared retrospectively three groups of patients with COPD: severe PH-COPD (n = 10), moderate PH-COPD (mPAP between 25 and 34 mm Hg without low cardiac index) (n = 10), and no PH (mPAP < 25 mm Hg) (n = 10). Histologic analysis of the explanted lungs examined the wall of medium-size arteries, the remodeling of microvessels, and the pulmonary capillary density using morphometric measurements performed on three sections per patient. RESULTS Compared with the moderate PH group, the remodeling score of the microvessels was significantly higher (P = .0045) and the capillary density was lower (P = .0049) in the severe PH-COPD group. The alterations of the medium-size arteries, important in group 1 PH, seemed less discriminating. CONCLUSIONS Patients with severe PH-COPD appear to have a specific histologic pattern, different from that observed in patients with COPD with moderate PH or without PH.
Collapse
Affiliation(s)
- Vincent Bunel
- Service de Pneumologie B et Transplantation Pulmonaire, Université Paris 7 Denis Diderot, Hôpital Bichat, Paris, France; INSERM U1152, Département Hospitalo-Universitaire FIRE, Laboratoire d'Excellence INFLAMEX, Université Paris 7 Denis Diderot, Paris, France
| | - Alice Guyard
- Département de Pathologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gaëlle Dauriat
- Service de Pneumologie B et Transplantation Pulmonaire, Université Paris 7 Denis Diderot, Hôpital Bichat, Paris, France
| | - Claire Danel
- INSERM U1152, Département Hospitalo-Universitaire FIRE, Laboratoire d'Excellence INFLAMEX, Université Paris 7 Denis Diderot, Paris, France; Département de Pathologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Montani
- Université Paris-Sud, AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, INSERM UMR_S 999, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Clément Gauvain
- INSERM U1152, Département Hospitalo-Universitaire FIRE, Laboratoire d'Excellence INFLAMEX, Université Paris 7 Denis Diderot, Paris, France
| | - Gabriel Thabut
- Service de Pneumologie B et Transplantation Pulmonaire, Université Paris 7 Denis Diderot, Hôpital Bichat, Paris, France; INSERM U1152, Département Hospitalo-Universitaire FIRE, Laboratoire d'Excellence INFLAMEX, Université Paris 7 Denis Diderot, Paris, France
| | - Marc Humbert
- Université Paris-Sud, AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, INSERM UMR_S 999, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Yves Castier
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Peter Dorfmüller
- Université Paris-Sud, AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, INSERM UMR_S 999, Hôpital de Bicêtre, Le Kremlin Bicêtre, Paris, France; Service d'Anatomie Pathologique, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Hervé Mal
- Service de Pneumologie B et Transplantation Pulmonaire, Université Paris 7 Denis Diderot, Hôpital Bichat, Paris, France; INSERM U1152, Département Hospitalo-Universitaire FIRE, Laboratoire d'Excellence INFLAMEX, Université Paris 7 Denis Diderot, Paris, France.
| |
Collapse
|
2
|
Dournes G, Laurent F, Coste F, Dromer C, Blanchard E, Picard F, Baldacci F, Montaudon M, Girodet PO, Marthan R, Berger P. Computed Tomographic Measurement of Airway Remodeling and Emphysema in Advanced Chronic Obstructive Pulmonary Disease. Correlation with Pulmonary Hypertension. Am J Respir Crit Care Med 2015; 191:63-70. [DOI: 10.1164/rccm.201408-1423oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
3
|
Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease. J Heart Lung Transplant 2012; 32:347-54. [PMID: 23265910 DOI: 10.1016/j.healun.2012.11.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/09/2012] [Accepted: 11/10/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pulmonary vascular findings are largely unreported in end-stage chronic obstructive pulmonary disease (COPD). METHODS Pulmonary vascular lesions in explanted lungs from 70 patients with COPD/emphysema or α-1-antitrypsin deficiency were analyzed retrospectively. Patients were stratified by the presence and severity of pulmonary hypertension (PH) assessed by right-heart catheterization in 3 hemodynamically distinct groups: (1) non-PH (mean pulmonary arterial pressure [mPAP]<25 mm Hg), (2) mild to moderate PH (mPAP, 25-34 mm Hg), and (3) severe PH (mPAP≥35 mm Hg). The control group comprised 18 patients with idiopathic pulmonary arterial hypertension (IPAH). Vascular lesions were graded 1-6 according to a modified Heath and Edwards (HE) scale. RESULTS All COPD patients were in New York Heart Association Functional Class III-IV (forced expiratory volume in 1 second, 23%±8%; total lung capacity, 128%±20% of predicted). Non-PH group: 30 patients (60% women) aged 54±6 years; mPAP, 17.2±3.8 mm Hg; median HE Grade 1 (range, 0-3), with medial hypertrophy of muscular pulmonary arteries and muscularization of pulmonary arterioles. Mild-moderate PH group: 30 patients (50% women) aged 53±6 years; mPAP, 28.6±2.8 mm Hg; median HE Grade 3 (range, 1-3), with additional cellular intimal proliferation. Severe PH group: 10 patients (50% women) aged 54±6 years; mPAP, 40.7±5.2 mm Hg; median HE Grade 3 (range, 2-5), with additional intimal fibrosis. IPAH controls: 18 patients (67% women) aged 36±4 years; mPAP,>50 mm Hg; median HE Grade 4 (range 3-6), with generalized arterial dilatation and plexiform lesions. CONCLUSIONS The extent of pulmonary vascular lesions in COPD correlate with the severity of PH. Morphologic lesions similar to those characteristic of IPAH can be observed as PH in COPD progresses to levels characteristic of IPAH.
Collapse
|
4
|
Mahut B, Chevalier-Bidaud B, Plantier L, Essalhi M, Callens E, Graba S, Gillet-Juvin K, Valcke-Brossollet J, Delclaux C. Diffusing Capacity for Carbon Monoxide is Linked to Ventilatory Demand in Patients with Chronic Obstructive Pulmonary Disease. COPD 2012; 9:16-21. [DOI: 10.3109/15412555.2011.630700] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
5
|
Dweik RA, Erzurum SC. Update on pulmonary vascular diseases 2010. Am J Respir Crit Care Med 2011; 184:26-31. [PMID: 21737591 DOI: 10.1164/rccm.201103-0394up] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Raed A Dweik
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | | |
Collapse
|
7
|
Girerd B, Montani D, Eyries M, Yaici A, Sztrymf B, Coulet F, Sitbon O, Simonneau G, Soubrier F, Humbert M. Absence of influence of gender and BMPR2 mutation type on clinical phenotypes of pulmonary arterial hypertension. Respir Res 2010; 11:73. [PMID: 20534176 PMCID: PMC2898773 DOI: 10.1186/1465-9921-11-73] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 06/10/2010] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies indicate that patients with pulmonary arterial hypertension (PAH) carrying a mutation in the bone morphogenetic protein receptor type 2 (BMPR2) gene, develop the disease 10 years earlier than non-carriers, and have a more severe hemodynamic compromise at diagnosis. A recent report has suggested that this may only be the case for females and that patients with missense mutations in BMPR2 gene have more severe disease than patients with truncating mutations. Methods We reviewed data from all patients with PAH considered as idiopathic and patients with a family history of PAH, who underwent genetic counselling in the French PAH network between January, 1st 2004 and April, 1st 2010. We compared clinical, functional, and hemodynamic characteristics between carriers and non-carriers of a BMPR2 mutation, according to gender or BMPR2 mutation type. Results PAH patients carrying a BMPR2 mutation (n = 115) were significantly younger at diagnosis than non-carriers (n = 267) (35.8 ± 15.4 and 47.5 ± 16.2 respectively, p < 0.0001). The presence of a BMPR2 mutation was associated with a younger age at diagnosis in females (36.4 ± 14.9 in BMPR2 mutation carriers and 47.4 ± 15.8 in non-carriers, p < 0.0001), and males (34.6 ± 16.8 in BMPR2 mutation carriers and 47.8 ± 17.1 in non-carriers, p < 0.0001). BMPR2 mutation carriers had a more severe hemodynamic compromise at diagnosis, but this was not influenced by gender. No differences in survival and time to death or lung transplantation were found in male and female PAH patients carrying a BMPR2 mutation. No differences were observed in clinical outcomes according to the type of BMPR2 mutations (missense, truncating, large rearrangement or splice defect). Conclusion When compared to non-carriers, BMPR2 mutation carriers from the French PAH network are younger at diagnosis and present with a more severe hemodynamic compromise, irrespective of gender. Moreover, BMPR2 mutation type had no influence on clinical phenotypes in our patient population.
Collapse
Affiliation(s)
- Barbara Girerd
- Faculté de Médecine, Université Paris-Sud, Kremlin-Bicêtre, F-94276, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|