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Aguirre-Franco C, Torres-Duque CA, Salazar G, Casas A, Jaramillo C, Gonzalez-Garcia M. Prevalence of pulmonary hypertension in COPD patients living at high altitude. Pulmonology 2024; 30:247-253. [PMID: 35151623 DOI: 10.1016/j.pulmoe.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA). OBJECTIVES To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m). METHODS Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted). RESULTS We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients. CONCLUSIONS The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.
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Affiliation(s)
- C Aguirre-Franco
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia.
| | - C A Torres-Duque
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
| | - G Salazar
- Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - A Casas
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
| | - C Jaramillo
- Universidad de La Sabana. Chía, Colombia; Fundación Clínica Shaio. Bogotá, Colombia
| | - M Gonzalez-Garcia
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
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Younis M, Al-Antary N, Dalbah R, Qarajeh A, Khanfar AN, Kar AA, Reddy R, Alzghoul BN. Echocardiography and pulmonary hypertension in patients with chronic obstructive pulmonary disease undergoing lung transplantation evaluation. Am J Med Sci 2024; 367:95-104. [PMID: 37967751 DOI: 10.1016/j.amjms.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/01/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The use of echocardiography in pulmonary hypertension (PH) in advanced chronic obstructive pulmonary disease (COPD) is understudied. We aimed to compare the performance of echocardiography with right heart catheterization (RHC) in the diagnosis of PH in COPD patients undergoing lung transplant evaluation. METHODS We included 111 patients with severe COPD who underwent RHC in a single center as part of lung transplantation evaluation. COPD-PH and severe COPD-PH were defined based on RHC per the 6th world symposium on pulmonary hypertension. Echocardiographic probability of PH was described according to the European Society of Cardiology guidelines. Summary and univariate analyses were performed. RESULTS The mean age (±SD) was 62 (8) and 47% (n=52) were men. A total of 82 patients (74 %) had COPD-PH. The sensitivity, specificity, positive predictive, and negative predictive values of echocardiography in diagnosing COPD-PH were 43 %, 83 %, 88 %, and 34 % respectively and for severe COPD-PH were 67 %, 75 %, 50 %, and 86 % respectively. Echocardiography was consistent with RHC in ruling in/out PH in 53% (n=59) of patients. After controlling for age, sex. BMI, pack year, echocardiography-RHC time difference, GOLD class, FVC, and CT finding of emphysema, higher TLC decreased consistency (parameter estimate=-0.031; odds ratio: 0.97, 95%CI 0.94-0.99; p=0.037) and higher DLCO increased consistency (parameter estimate=0.070; odds ratio: 1.07, 95%CI 0.94-0.99; p=0.026). CONCLUSIONS Echocardiography has high specificity but low sensitivity for the diagnosis of PH in advanced COPD. Its performance improves when ruling out severe COPD-PH. This performance correlates inversely with lung hyperinflation.
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Affiliation(s)
- Moustafa Younis
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, United States.
| | | | - Rami Dalbah
- Internal Medicine, East Tennessee State University, Johnson City, Tennessee, United States
| | - Ahmad Qarajeh
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Asim N Khanfar
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Abdullah Abu Kar
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, United States
| | - Raju Reddy
- Pulmonary, Critical Care and Sleep Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Bashar N Alzghoul
- Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, United States
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Hereijgers MJ, van der Velden RM, el Moussaoui N, Verhaert DV, Habibi Z, Luermans J, den Uijl D, Chaldoupi SM, Vernooy K, Schotten U, Baumert M, Gietema HA, Mihl C, Koltowski L, Franssen FM, Simons SO, Linz D. Repurposing catheter ablation work-up to detect expiratory airflow limitation in patients with atrial fibrillation. IJC HEART & VASCULATURE 2023; 49:101305. [PMID: 38053981 PMCID: PMC10694302 DOI: 10.1016/j.ijcha.2023.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
Background In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for expiratory airflow limitation, but existing examinations can help identify at-risk individuals. We aimed to assess the diagnostic value of repurposing existing assessments from the pre-ablation work-up to identify and understand the characteristics of affected patients. Methods We screened 110 consecutive AF patients scheduled for catheter ablation with handheld spirometry. Routine pre-ablation work-up included cardiac computed tomographic angiography (CCTA), transthoracic echocardiography and polygraphy. CCTA was analyzed qualitatively for emphysema and airway abnormalities. Multivariate logistic regression analysis was performed to determine predictors of expiratory airflow limitation. Results We found that 25 % of patients had expiratory airflow limitation, which was undiagnosed in 86 % of these patients. These patients were more likely to have pulmonary abnormalities on CCTA, including emphysema (odds ratio [OR] 4.2, 95 % confidence interval [CI] 1.12-15.1, p < 0.05) and bronchial wall thickening (OR 2.6, 95 % CI 1.0-6.5, p < 0.05). The absence of pulmonary abnormalities on CCTA accurately distinguished patients with normal lung function from those with airflow limitation (negative predictive value: 85 %). Echocardiography and polygraphy did not contribute significantly to identifying airflow limitation. Conclusions In conclusion, routine pre-ablation CCTA can detect pulmonary abnormalities in AF patients with airflow limitation, guiding further pulmonary assessment. Future studies should investigate its impact on ablation procedure success.
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Affiliation(s)
- Maartje J.M. Hereijgers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Nora el Moussaoui
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dominique V.M. Verhaert
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zarina Habibi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Dennis den Uijl
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Mathias Baumert
- Discipline of Biomedical Engineering, The University of Adelaide, Adelaide, Australia
| | - Hester A. Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Casper Mihl
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lukasz Koltowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sami O. Simons
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ra F, Cl G, Pb S, Rs M, Sm F, Fpg R, Rg M, A BS, Mg R. Association of right ventricle diastolic diameter with pulmonary function, exercise tolerance and exacerbation period in patients with chronic obstructive pulmonary disease: A prospective study. Heart Lung 2022; 55:11-15. [PMID: 35427832 DOI: 10.1016/j.hrtlng.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The echocardiogram is a useful method for monitoring the cardiovascular complications of chronic obstructive pulmonary disease (COPD), but it is not clear if morphological and functional cardiac variables are able to identify patients with unfavorable COPD progression. OBJECTIVE The aim of this study was to investigate morphological and functional echocardiographic variables associated with exacerbation of the disease, pulmonary function parameters and functional capacity evaluation in COPD patients. METHOD A longitudinal observational study including 91 patients diagnosed with COPD, who were stratified in two groups according to their basal right ventricle diastolic diameter (RVDD) measuring greater and less than 35 mm. They underwent clinical evaluation, echocardiography, spirometry and 6-minute walking-test (6MWT). RESULTS The study found that patients with RVDD greater than 35 mm showed worse functional capacity in the 6MWT (p = 0.05) and more exacerbation of the disease during the one-year follow-up (p = 0.05). There were correlations of greater RVDD vs forced vital capacity (R = -0.27; p = 0.02) and distance in the 6MWT (R = 0.55; p = 0.03) in patients with exacerbation. In the univariate regression analysis, the RVDD was responsible for 55% of the variation in distance in the 6MWT (-0.75 m) in COPD patients. CONCLUSION The RV dilation is associated with unfavorable prognostic markers in COPD, such as the worsening of the functional capacity and more frequent exacerbations. The echocardiogram may be a useful tool to identify patients who need more aggressive strategies to control the evolution of the disease with potential impact in pulmonary rehabilitation.
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Affiliation(s)
- Faria Ra
- Biotechnology, Cardiology and Exercise Research Center Laboratory, Department of Medicine, Federal University of São Carlos, SP, Brazil
| | - Goulart Cl
- Physiotherapy, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Santos Pb
- Federal University of São Carlos, SP, Brazil
| | - Marinho Rs
- Physiotherapy, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Firmino Sm
- Federal University of São Carlos, SP, Brazil
| | - Rizzatti Fpg
- Department of Medicine, Pulmonary Division, São Paulo Federal University, São Paulo, Brazil
| | - Mendes Rg
- Physiotherapy Department, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Borghi-Silva A
- Physiotherapy Department, Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, SP, Brazil
| | - Roscani Mg
- Department of Medicine, Cardiology and Exercise Research Center Laboratory Coordinator, Department of Medicine, Federal University of São Carlos, Washington Luiz, Km 235, São Carlos, SP, Brazil.
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Aurangabadkar GM, Lanjewar AV, Jadhav US, Ali SN, Wagh PB. Evaluation of Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease. Cureus 2022; 14:e21828. [PMID: 35291532 PMCID: PMC8896257 DOI: 10.7759/cureus.21828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is frequently underdiagnosed and under-evaluated in chronic obstructive pulmonary diseases (COPD) patients. As PH is linked to a high rate of mortality from disease-related complications like cor pulmonale, it is critical to have a unified approach to diagnosing and treating it with the aim of improving the patient's quality of life and prognosis in terms of therapeutic considerations. Early identification of this comorbidity in patients with COPD can lead to early initiation of treatment and better prognostic implications. This study was undertaken with the aim of estimating the prevalence of PH in COPD as well as assessing any statistically significant associations between the severity of PH and the severity of COPD. Methods: This was an observational study undertaken at the Department of Respiratory Medicine, Acharya Vinoba Bhave Rural Hospital (AVBRH) in Wardha, Maharastra, India, from August 2019 to September 2021. A total of 100 patients diagnosed with COPD on the basis of spirometry were evaluated with two-dimensional (2D) echocardiography to screen for echocardiographic signs and evidence of PH and severity staging of PH if present. Results: In our study, out of 100 diagnosed cases of COPD, the prevalence of PH was found to be 40% (40 patients) and amongst these, mild, moderate, and severe PH was seen in 26 patients (26%), nine patients (9%), and five patients (5%), respectively. The frequency of PH in moderate COPD was 25% and in severe COPD was 51.5%. Conclusions: PH was found in almost half the COPD patients in the study. Also, the degree and frequency of PH increased with the increase in COPD severity and this was found to be statistically significant.
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Wernhart S, Hedderich J. Prediction of pulmonary hypertension in older adults based on vital capacity and systolic pulmonary artery pressure. JRSM Cardiovasc Dis 2020; 9:2048004020973834. [PMID: 33240494 PMCID: PMC7672752 DOI: 10.1177/2048004020973834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Right heart catheterization (RHC) is associated with a higher procedural risk in older adults, but non-invasive estimation of pulmonary hypertension (PH) is a challenge. We aimed to elaborate a non-invasive prediction model to estimate PH. Methods and design We retrospectively analysed 134 older adults (70.0 years ±12.3; 44.9% males) who reported to our clinic with unclear dyspnea between 01/2015 and 01/2020 and had received RHC as a part of their diagnostic workup. Lung function testing, analysis of blood gas samples, 6 min walk distance and echocardiography were performed within 24 hours of RHC. Main outcome measures In a stepwise statistical approach by using an in/exclusion algorithm (using the AIC criterion) we analysed non-invasive parameters to test their value in predicting PH (defined as mean pulmonary artery pressure, PAmean, >25mmHg). Discrimination capability of the final model was measured by the AUC (area under curve) from an ROC (receiver operating characteristics) analysis. Results We yielded a sensitivity of 87.2% and a specificity of 62.5% in a combinatorial logistical model with systolic pulmonary artery pressure (sPAP) and forced vital capacity (VCmax), the discrimination index was 86.7%. The odds ratios for an increase of 10 mmHg of sPAP were 2.99 (2.08–4.65) and 1.86 (1.11–3.21) for a 1 l decrease in VCmax. On their own, VCmax proved to be specific (83.3%), while sPAP was a sensitive (79.1%) predictor for PH. Conclusions We provide a combinatorial model to predict PH from sPAP and VCmax in older adults, which may help to avoid invasive procedures.
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Affiliation(s)
- Simon Wernhart
- Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany.,West German Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jürgen Hedderich
- Medistat-Biomedical Statistics, Medistat GmbH, Kronshagen, Germany
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Buklioska-Ilievska D, Minov J, Kochovska-Kamchevska N, Prgova-Veljanova B, Petkovikj N, Ristovski V, Baloski M. Cardiovascular Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Echocardiography Changes and Their Relation to the Level of Airflow Limitation. Open Access Maced J Med Sci 2019; 7:3568-3573. [PMID: 32010378 PMCID: PMC6986525 DOI: 10.3889/oamjms.2019.848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 01/13/2023] Open
Abstract
AIM To compare the frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. METHODS Study population included 120 subjects divided into two groups. Group 1 included 60 patients with COPD (52 male and 8 females, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire, pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. RESULTS We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 mm vs. 24.4 ± 4.3 mm; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (33.3% vs. 0%; P = 0.0004) showing a linear relationship with the severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs 64.8 ± 2.7%; P = 0.0000) with no correlation with severity of airflow limitation. CONCLUSION Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with the severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention.
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Affiliation(s)
| | - Jordan Minov
- Institute for Occupational Health of Republic of Macedonia - WHO Collaborating Center, Skopje, Republic of Macedonia
| | | | | | | | | | - Marjan Baloski
- General Hospital, “8th September”, Skopje, Republic of Macedonia
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Limitación al flujo aéreo en pacientes con insuficiencia cardíaca: prevalencia y factores asociados. Med Clin (Barc) 2019; 153:191-195. [DOI: 10.1016/j.medcli.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/26/2018] [Accepted: 11/08/2018] [Indexed: 11/18/2022]
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Gulbas G, Turan O, Sarioglu N, Diken OE, Ogan N, Ekbic Kadioglu E, Kurtipek E, Bozkus F, Yilmaz Demirci N, Coskun Beyan A, Mutlu LC, Sahin Duyar S, Deniz S, Fazlioglu N, Sengul A, Tanriverdi H, Okutan O, Turan PA, İnonu H, Ortakoylu MG, Lakadamyali H, Kivanc T, Atli O, Özdemir O, Filiz Koşar A, Mirici A, Suerdem M. Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study. CLINICAL RESPIRATORY JOURNAL 2019; 13:391-399. [PMID: 30942958 DOI: 10.1111/crj.13024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/19/2019] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. OBJECTIVE It was aimed to determine relationship and survival between COPD and CIMT. METHODS CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. RESULTS There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT ≥ 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). CONCLUSION This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.
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Affiliation(s)
- Gazi Gulbas
- Department of Pulmonary Medicine, Turgut Ozal Research Center, Inonu University, Malatya, Turkey
| | - Onur Turan
- Department of Pulmonary Medicine, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nurhan Sarioglu
- Department of Pulmonary Medicine, Balikesir University, Balikesir, Turkey
| | | | - Nalan Ogan
- Department of Pulmonary Medicine, Ufuk University, Ankara, Turkey
| | - Esra Ekbic Kadioglu
- Department of Pulmonary Medicine, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Ercan Kurtipek
- Department of Pulmonary Medicine, Konya Training and Research Hospital, Konya, Turkey
| | - Fulsen Bozkus
- Department of Pulmonary Medicine, Sutcu Imam University, K. Maras, Turkey
| | | | - Ayşe Coskun Beyan
- Department of Pulmonary Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Levent Cem Mutlu
- Department of Pulmonary Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Sezgi Sahin Duyar
- Department of Pulmonary Medicine, Beypazari State Hospital, Ankara, Turkey
| | - Sami Deniz
- Department of Pulmonary Medicine, Didim State Hospital, Mugla, Turkey
| | - Nevin Fazlioglu
- Department of Pulmonary Medicine, Acibadem Hospital, Kayseri, Turkey
| | - Aysun Sengul
- Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hakan Tanriverdi
- Department of Pulmonary Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Oğuzhan Okutan
- Department of Pulmonary Medicine, GATA, Training and Research Hospital, Istanbul
| | - Pakize Ayse Turan
- Department of Pulmonary Medicine, Menemen State Hospital, Izmir, Turkey
| | - Handan İnonu
- Department of Pulmonary Medicine, Gazi Osman Pasa University, Tokat, Turkey
| | | | | | - Tulay Kivanc
- Department of Pulmonary Medicine, Baskent University, Konya, Turkey
| | - Ozgur Atli
- Department of Pulmonary Medicine, Diyarbakir State Hospital, Diyarbakir, Turkey
| | | | - A Filiz Koşar
- Department of Pulmonary Medicine, Saglik Bilimleri University, Istanbul, Turkey
| | - Arzu Mirici
- Department of Pulmonary Medicine, 18 Mart University, Canakkale, Turkey
| | - Mecit Suerdem
- Department of Pulmonary Medicine, Selcuk University, Konya, Turkey
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Șuteu CC, Muntean I, Blesneac C, Căpîlna B, Benedek T, Togănel R. A Correlative Study of Spirometric Parameters and Markers of Right Ventricular Dysfunction in Pediatric Patients with Pulmonary Arterial Hypertension. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: Alteration in lung function is present in children with pulmonary arterial hypertension (PAH). We aimed to study the pulmonary function indices obtained by spirometry in pediatric patients with PAH, and to correlate them with B-type natriuretic peptide (BNP) and echocardiographic parameters.
Methods: Thirty-one children with PAH were enrolled in this study, of those 26 patients (83.87%) associated shunt defect and 5 patients (16.12%) were diagnosed with idiopathic PAH. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), forced expiratory flow at 25–75% of the pulmonary volume (FEF 25–75) were evaluated by spirometry and correlated with BNP and echocardiographic parameters that reflect right ventricle function.
Results: Restrictive pattern of pulmonary function was present in 51.6% (n = 16) of all PAH children. There were significant correlations between BNP with FVC (p = 0.001), FEV1 (p = 0.001), and FEV1/FVC (p = 0.001). Serum BNP level was significantly increased in the group of patients without shunt. Of those echocardiographic parameters that reflect right ventricle function, we found that TAPSE significantly correlated with PEFR (r = −0.47, p <0.01), and with FEF 25–75 (r = −0.39, p <0.01).
Conclusions: Deterioration of the pulmonary function indices are correlated with BNP and echocardiographic parameters, markers of RV dysfunction. Being easy and reliable tests, pulmonary functions can be introduced among the follow-up tools in children with PAH.
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Affiliation(s)
- Carmen Corina Șuteu
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Iolanda Muntean
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Cristina Blesneac
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Brîndușa Căpîlna
- Pediatric Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
| | - Theodora Benedek
- Department M3, Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Rodica Togănel
- Department M4, III rd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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Kaushal M, Shah PS, Shah AD, Francis SA, Patel NV, Kothari KK. Chronic obstructive pulmonary disease and cardiac comorbidities: A cross-sectional study. Lung India 2016; 33:404-9. [PMID: 27578933 PMCID: PMC4948228 DOI: 10.4103/0970-2113.184874] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is a global health issue with cigarette smoking being an important risk factor. COPD affects pulmonary blood vessels, right ventricle, as well as left ventricle leading to the development of pulmonary hypertension (PH), cor-pulmonale (COR-P), right and left ventricular dysfunction. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate cardiac functions. Early diagnoses and intervention for cardiac comorbidities would reduce mortalities. Materials and Methods: A cross-sectional study. Total 50 patients of moderate to severe COPD according to GOLD guidelines were taken from Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara. All patients underwent investigations such as chest X-ray PA view, ECG, and spirometry followed by two-dimensional echocardiography. Results: We investigated 49 males and 1 female patients ranging from 35 to 80 years of age. Twenty-nine individuals were of moderate COPD and twenty-one of severe COPD. Of these cases 29 had left ventricular diastolic dysfunction (LVDD) changes, 24 were diagnosed with PH and 16 had changes of COR-P. The study showed the linear relation between the severity of LVDD, PH, and COR-P with the severity of COPD. Conclusion: Our study put emphasis on early cardiac screening of all COPD patients which will be helpful in the assessment of the prognosis and will further assist in identifying the individuals likely to suffer increase morbidity and mortality.
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Affiliation(s)
- Mohit Kaushal
- Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Parth S Shah
- Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Arti D Shah
- Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Stani A Francis
- Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Nihar V Patel
- Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
| | - Kavit K Kothari
- Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
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Deveci B, Baser K, Gul M, Sen F, Kafes H, Avci S, Temizer O, Ozeke O, Tufekcioglu O, Golbasi Z. Right ventricular outflow tract function in chronic heart failure. Indian Heart J 2016; 68 Suppl 1:S10-4. [PMID: 27056647 PMCID: PMC4824327 DOI: 10.1016/j.ihj.2015.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 07/07/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a common, progressive, complex clinical syndrome and a subset of HF patients has symptoms out of proportion to the resting hemodynamics and left ventricular ejection fraction (LVEF). Right ventricular (RV) function is a powerful prognostic factor in HF, but assessing it is a challenge because of the right ventricle's complex geometry. OBJECTIVE The aim of this study was to investigate the clinical application value of RV outflow tract (RVOT) function measured by transthoracic echocardiography in HF patients. METHOD We prospectively investigated 36 chronic HF patients with dilated heart and LV systolic dysfunction and 21 healthy control subjects (normal ventricular function and ECG, and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were analyzed. RESULTS The RVOT-FS was less in HF patients than healthy controls (18.8±15.7 vs 55.8±6.7, p<0.001) and correlated positively with TAPSE (r=0.814, p<0.001) and inversely with SPAP (r=-0.728, p<0.001) and functional capacity (r=-0.842, p<0.001). There was a statistically significant difference in RVOT-FS among the HF subgroups with regard to NYHA functional capacity (p<0.001), although there was no statistically significant difference with regard to LVEF. CONCLUSION Although the apparent discordance between LVEF and the degree of functional impairment in HF is not well understood, it may be explained in part by alterations in RV function. We found that the RVOT-FS was a noninvasive and easily applicable measure of RV function and might be used for a comprehensive evaluation and follow-up of HF patients with a combined assessment of RV by other RV parameters.
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Affiliation(s)
- Bulent Deveci
- Akay Hospital, Department of Cardiology, Ankara, Turkey
| | - Kazim Baser
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Murat Gul
- Van Ercis State Hospital, Department of Cardiology, Van, Turkey
| | - Fatih Sen
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Habibe Kafes
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Sedat Avci
- Tatvan State Hospital, Department of Cardiology, Bitlis, Turkey
| | - Orkun Temizer
- Burdur State Hospital, Department of Cardiology, Burdur, Turkey
| | - Ozcan Ozeke
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
| | - Omac Tufekcioglu
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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Geyik B, Tarakci N, Ozeke O, Ertan C, Gul M, Topaloglu S, Aras D, Demir AD, Tufekcioglu O, Golbasi Z, Aydogdu S. Right ventricular outflow tract function in chronic obstructive pulmonary disease. Herz 2013; 40:624-8. [PMID: 24173376 DOI: 10.1007/s00059-013-3978-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/08/2013] [Accepted: 08/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is clinically important to evaluate the severity of right ventricular (RV) overload in patients with chronic obstructive pulmonary disease (COPD), which is often associated with changes in the structure and the function of the right ventricle. Noninvasive and reliable assessment of RV function would be an essential determinant of RV load and a clinically useful factor for assessing cardiovascular risk in COPD patients. OBJECTIVE The aim of this study was to investigate the clinical application value of right ventricular outflow tract (RVOT) systolic function measured by transthoracic echocardiography in patients with COPD. PATIENTS AND METHODS We prospectively investigated COPD male patients and compared them with healthy controls. In addition to RV conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were also assessed. RESULTS Fifty-five COPD patients (all men; mean age, 62 ± 9 years) participated in the study, and were compared with a control group consisting of 21male, healthy, nonsmoking subjects with a mean age of 58 ± 11 years. The RVOT-FS was impaired in COPD patients than healthy controls (27.8 ± 15.5 vs. 57.5 ± 8.6, p < 0.001), and was correlated positively with tricuspid annular plane systolic excursion (TAPSE; r = 0.583, p < 0.001) and pulmonary acceleration time (r = 0.666, p < 0.001) and inversely with pulmonary artery systolic pressure (r = 0.605, p < 0.001) and functional capacity(r = - 0.589, p < 0.001). There was a statistically significant difference in RVOT-FS among the COPD subgroups with regard to New York Heart Association functional classification (p < 0.001). CONCLUSION The RVOT-FS is a noninvasive easily applicable measure of RV systolic function and is well correlated with functional capacity in COPD patients. Its combination with long-axis measurements via TAPSE and transtricuspid Doppler analysis may provide a comprehensive evaluation of the RV performance in COPD patients.
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Affiliation(s)
- B Geyik
- Department of Cardiology, Trakya University, Edirne, Turkey
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15
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Long term survival of patients with raised pulmonary arterial systolic pressure utilizing echocardiography-a five-year prospective study. J Geriatr Cardiol 2013; 9:328-35. [PMID: 23341836 PMCID: PMC3545248 DOI: 10.3724/sp.j.1263.2012.06191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/29/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022] Open
Abstract
Background Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evaluated the mortality and hospitalization rates of subjects with raised PASP in a cohort of patients referred directly by their general practitioners for routine outpatient (open access) echocardiography for further analysis of suspected heart failure. Results A total of 485 subjects were referred for open access echocardiography at our hospital in 2002. A cohort of 209/485 (43%) consecutive subjects with measurable tricuspid regurgitation were followed for a minimum of five years investigating hospitalization rates and survival. Some 62 of 209 (30%) subjects had pulmonary hypertension (PH). Subjects with PH were significantly more likely to have four or more hospital admissions (22% vs. 8%; P < 0.01) and > 30 days of cumulative hospital stay over five years (29% vs. 13%; P < 0.01). PH was significantly associated with mortality (P = 0.003), while moderate to severe PH was an independent predictor of mortality (hazard ratio: 4.31; 95% confidence interval (95% CI): 1.51–12.30). Records from the Office of National Statistics revealed that subjects with PH were more likely to have chronic lung diseases recorded as immediate or contributory causes of death (50% vs. 14%; P < 0.05). Conclusions PASP ≥ 36 mmHg on routine echocardiography is associated with recurrent hospital admissions, prolonged hospitalizations and increased cause of mortality. Therefore, the diagnosis of PH on echocardiography deserves further clinical evaluation, with future studies designed at defining a suitable diagnostic strategy.
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Shaw JG, Dent AG, Passmore LH, Burstow DJ, Bowman RV, Zimmerman PV, Fong KM, Yang IA. Genetic influences on right ventricular systolic pressure (RVSP) in chronic obstructive pulmonary disease (COPD). BMC Pulm Med 2012; 12:25. [PMID: 22695028 PMCID: PMC3431274 DOI: 10.1186/1471-2466-12-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a complication of chronic obstructive pulmonary disease (COPD). This study examined genetic variations in mediators of vascular remodelling and their association with PH in patients with COPD. In patients with COPD, we genotyped 7 SNPs in 6 candidate PH genes (NOS3, ACE, EDN1, PTGIS, SLC6A4, VEGFA). We tested for association with right ventricular systolic pressure (RVSP), spirometry and gas transfer, and hypoxemia. METHODS In patients with COPD, we genotyped 7 SNPs in 6 candidate PH genes (NOS3, ACE, EDN1, PTGIS, SLC6A4, VEGFA). We tested for association with right ventricular systolic pressure (RVSP), spirometry and gas transfer, and hypoxemia. RESULTS 580 COPD patients were recruited, 341 patients had a transthoracic echocardiogram, with RVSP measurable in 278 patients (mean age 69 years, mean FEV1 50% predicted, mean RVSP 44 mmHg, median history of 50 pack-years). Of the 7 tested SNPs, the NOS3-VNTR polymorphism was significantly associated with RVSP in a dose-dependent fashion for the risk allele: mean RVSP for a/a and a/b genotypes were 52.0 and 46.6 mmHg respectively, compared to 43.2 mmHg for b/b genotypes (P = 0.032). No associations were found between RVSP and other polymorphisms. ACE II or ID genotypes were associated with a lower FEV1% predicted than the ACE DD genotype (P = 0.028). The NOS3-298 TT genotype was associated with lower KCO % predicted than the NOS3-298 GG or GT genotype (P = 0.031). CONCLUSIONS The NOS3-VNTR polymorphism was associated with RVSP in patients with COPD, supporting its involvement in the pathogenesis of PH in COPD. ACE and NOS3 genotypes were associated with COPD disease severity, but not with the presence of PH. Further study of these genes could lead to the development of prognostic and screening tools for PH in COPD.
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Affiliation(s)
- Janet G Shaw
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Annette G Dent
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Linda H Passmore
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD 4032, Australia
| | - Darryl J Burstow
- Department of Echocardiography, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD, 4032, Australia
| | - Rayleen V Bowman
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Paul V Zimmerman
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Kwun M Fong
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
| | - Ian A Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD, 4067, Australia
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Pandey AK, Wilcox P, Mayo JR, Moss R, Ellis J, Brown J, Kavishwar A, Leipsic J. Oesophageal dilatation on high-resolution CT chest in systemic sclerosis: what does it signify? J Med Imaging Radiat Oncol 2012; 55:551-5. [PMID: 22141601 DOI: 10.1111/j.1754-9485.2011.02317.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the significance of oesophageal dilatation on high-resolution CT (HRCT) chest in patients with systemic sclerosis. METHODS We retrospectively retrieved the database of patients with systemic sclerosis seen at our hospital between January 2008 and January 2009. A total of 50 patients (46 women and four men) who had HRCT chest, pulmonary function testing and echocardiography within 1 month were included in the study. Peak pulmonary artery (PA) pressures and pulmonary function testing were charted. The HRCT chest was interpreted by a chest radiologist. Oesophageal dilatation was defined as a luminal coronal diameter of ≥9 mm in infra-aortic oesophagus. Extent of ground glass, reticulation and honeycombing was objectively scored. RESULTS Statistical analysis using independent t-test showed that diffusion capacity of carbon monoxide was significantly lower (P = 0.042) and peak PA pressures were significantly higher (P = 0.045) in patients with oesophageal dilatation (n = 29) as compared with those without oesophageal dilatation (n = 21). The two cohorts had no significant difference in their total lung capacity and HRCT determined extent of interstitial lung disease. CONCLUSION Patients with oesophageal dilatation on HRCT chest had significantly lower diffusion capacity of carbon monoxide and higher peak PA pressures, which suggest that these patients tend to have more severe pulmonary vascular disease.
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Affiliation(s)
- Anoop Kumar Pandey
- Department of Radiology, Division of Pulmonary Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Sertogullarindan B, Gumrukcuoglu HA, Sezgi C, Akil MA. Frequency of pulmonary hypertension in patients with COPD due to biomass smoke and tobacco smoke. Int J Med Sci 2012; 9:406-12. [PMID: 22859900 PMCID: PMC3410359 DOI: 10.7150/ijms.4715] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 07/16/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Pulmonary hypertension (PH) is a common and well established complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with decreased survival. This study was designed to investigate the PH frequency and its relations in hospitalized tobacco and biomass related COPD patients. METHODS AND RESULTS The study was a retrospective review of inpatients with COPD defined as a history of tobacco or biomass smoking, Pulmonary function tests (PFT) within stable status, an echocardiogram within stable status. PH was defined as systolic pulmonary artery pressure (sPAP) >35 mmHg. Of the 694 individuals, 600 had suitable aspects for inclusion of study. All Females were biomass exposer and males were tobacco smoker. The Prevalence of PH was found more frequent in females than males. It was more prominent in moderate level COPD cases (56,2% and 37,5%, P<0,002). Both groups had airflow limitation, hypercapnia and hypoxemia, but no differences were found in terms of PaCO(2) and PaO2. However, FEV1 % was lower in males than females (p<0,005). On the other hand, FVC % was lower in the females compared with the males (p < 0.02). When analyzing the influence of PFT and demographic parameters on PH in separate COPD level groups, the results a bit varied among the groups. CONCLUSION Our study demonstrated that PH frequency is higher in female COPD cases due to biomass smoke than in male COPD cases due to tobacco smoke. The influence of FVC % on the risk of a person having PH increased with increasing COPD level.
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Cuttica MJ, Shah SJ, Rosenberg SR, Orr R, Beussink L, Dematte JE, Smith LJ, Kalhan R. Right heart structural changes are independently associated with exercise capacity in non-severe COPD. PLoS One 2011; 6:e29069. [PMID: 22220201 PMCID: PMC3248404 DOI: 10.1371/journal.pone.0029069] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/20/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) occurs frequently and results in functional limitation in advanced COPD. Data regarding the functional consequence of PH in less severe COPD are limited. Whether echocardiographic evidence of right sided heart pathology is associated with functional outcomes in patients with non-severe COPD is unknown. METHODS We evaluated pulmonary function, six minute walk distance, and echocardiography in 74 consecutive patients with non-severe COPD. We performed multivariable linear regression to evaluate the association between right heart echocardiographic parameters and six minute walk distance adjusting for lung function, age, sex, race, and BMI. MAIN RESULTS The mean six minute walk distance was 324±106 meters. All subjects had preserved left ventricular (LV) systolic function (LV ejection fraction 62.3%±6.1%). 54.1% had evidence of some degree of diastolic dysfunction. 17.6% of subjects had evidence of right ventricular enlargement and 36.5% had right atrial enlargement. In univariate analysis RV wall thickness (β = -68.6; p = 0.002), log right atrial area (β = -297.9; p = 0.004), LV mass index (β = -1.3; p = 0.03), E/E' ratio (β = -5.5; p = 0.02), and degree of diastolic dysfunction (β = -42.8; p = 0.006) were associated with six minute walk distance. After adjustment for co-variables, the associations between right atrial area (log right atrial area β = -349.8; p = 0.003) and right ventricular wall thickness (β = -43.8; p = 0.04) with lower six minute walk distance remained significant independent of forced expiratory volume in one second (FEV1). LV mass index, E/E' ratio, and degree of diastolic dysfunction were not independent predictors of six minute walk distance. CONCLUSION In patients with non-severe COPD right sided cardiac structural changes are associated with lower six minute walk distance independent of lung function. These findings may indicate that echocardiographic evidence of pulmonary hypertension is present in patients with non-severe COPD and has important functional consequences.
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Affiliation(s)
- Michael J Cuttica
- Pulmonary Hypertension Program, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States of America.
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21
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Pulmonary hypertension in a stable community-based COPD population. Lung 2011; 189:377-82. [PMID: 21814783 DOI: 10.1007/s00408-011-9315-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVES The etiology and prevalence of pulmonary hypertension (PH) in patients with stable chronic obstructive pulmonary disease (COPD) is uncertain. This study was done to determine the prevalence of PH in stable COPD outpatients and to evaluate the relationship between PH and indices of pulmonary function. DESIGN The study was a retrospective review of outpatients with COPD and PH defined as a history of cigarette smoking, pulmonary function tests (PFTs) that met GOLD criteria for airway obstruction, an echocardiogram within 6 months of PFTs, and a left ventricular ejection fraction (LVEF) >55%. Of the 159 individuals who met all inclusion criteria, 105 had a sufficient tricuspid regurgitant jet to measure systolic pulmonary artery pressure (sPAP). PH was defined as sPAP ≥36 mmHg. MEASUREMENTS AND RESULTS The prevalence of PH was 60% (63/105) in the study group. The mean sPAP in patients with PH was 45 ± 6 mmHg. COPD patients with PH were older (71.1 ± 11.8 vs. 63.7 ± 10.2 years, P = 0.001), had lower FEV(1)% predicted (51.8 ± 18.8 vs. 62.7 ± 20.5%, P = 0.006), a higher RV/TLC (0.55 ± 0.10 vs. 0.48 ± 0.11, P = 0.001), and a lower % predicted DL(CO) (59.6 ± 19.5% vs. 71.9 ± 24.9%, P = 0.006). Only age (P < 0.002) and prebronchodilator FEV(1)% predicted (P < 0.006) predicted PH by logistic regression analysis. No differences were observed in gender, BMI, smoking status, pack years, total lung capacity (TLC), or residual volume (RV). CONCLUSION PH is common in COPD. Older individuals and those with more airway obstruction are at greater risk for developing PH.
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Kiakouama L, Cottin V, Glerant JC, Bayle JY, Mornex JF, Cordier JF. Conditions associated with severe carbon monoxide diffusion coefficient reduction. Respir Med 2011; 105:1248-56. [DOI: 10.1016/j.rmed.2011.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 11/28/2022]
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Gupta NK, Agrawal RK, Srivastav AB, Ved ML. Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease. Lung India 2011; 28:105-9. [PMID: 21712919 PMCID: PMC3109831 DOI: 10.4103/0970-2113.80321] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes. Aims: To assess the cardiac changes secondary to COPD by echocardiography and to find out the correlation between echocardiographic findings and severity of COPD, if there is any. Materials and Methods: A total 40 of patients of COPD were selected and staged by pulmonary function test (PFT) and evaluated byechocardiography. Results: On echocardiographic evaluation of COPD, 50% cases had normal echocardiographic parameters. Measurable tricuspid regurgitation (TR) was observed in 27/40 cases (67.5%). Pulmonary hypertension (PH), which is defined as systolic pulmonary arterial pressure (sPAP)> 30 mmHg was observed in 17/27 (63%) cases in which prevalence of mild, moderate, and severe PH were 10/17 (58.82%), 4/17 (23.53%), and 3/17 (17.65%), respectively. The frequencies of PH in mild, moderate, severe, and very severe COPD were 16.67%, 54.55%, 60.00%, and 83.33%, respectively. Right atrial pressure was 10 mmHg in 82.5% cases and 15 mmHg in 17.5% cases. Cor pulmonale was observed in 7/17 (41.17%) cases; 7.50% cases had left ventricle (LV) systolic dysfunction and 47.5% cases had evidence of LV diastolic dysfunction defined as A ≥ E (peak mitral flow velocity of the early rapid filling wave (E), peak velocity of the late filling wave caused by atrial contraction (A) on mitral valve tracing) Left ventricle hypertrophy was found in 22.5% cases. Conclusion: Prevalence of PH has a linear relationship with severity of COPD and severe PH is almost associated with cor pulmonale. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions.
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Affiliation(s)
- N K Gupta
- Department of Tuberculosis and Chest Diseases, R N T Medical College, Udaipur, Rajasthan, India
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Stone AC, Machan JT, Mazer J, Casserly B, Klinger JR. Echocardiographic evidence of pulmonary hypertension is associated with increased 1-year mortality in patients admitted with chronic obstructive pulmonary disease. Lung 2011; 189:207-12. [PMID: 21556789 DOI: 10.1007/s00408-011-9293-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 04/03/2011] [Indexed: 01/14/2023]
Abstract
Pulmonary hypertension (PH) is associated with decreased overall survival in patients with chronic lung disease. The purpose of this study was to determine the effect of echocardiographic evidence of PH on 1-year survival in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (COPD). This is a retrospective study of patients admitted to a respiratory intermediate care unit with COPD exacerbation between October 1, 2002 and September 30, 2004. All patients who had 2D echocardiograms and pulmonary function tests done within 12 months prior to hospital admission or during the admission were examined. Charts were reviewed for the following outcomes: length of hospital stay, need for mechanical ventilation, survival at discharge, and mortality over the next year. Data were analyzed using multiple logistic regression and p values calculated using Fisher's exact test. Forty-three patients met study entry criteria, and PH, defined as systolic right ventricular pressure greater than 45 mmHg, was found in 23 (53%). Sixteen of the 23 patients (70%) with PH died during the 1-year follow-up period compared to 5 of 20 (25%) patients with no PH (p = 0.0058). The effect of PH on survival was independent of age, forced expiratory volume in 1 s (FEV(1)), arterial pH, pCO(2), or pO(2) (p < 0.01). Echocardiographic evidence of PH is associated with increased 1-year mortality in patients admitted with COPD exacerbation. Further studies are needed to determine if PH is a cause of increased mortality in this population or an indicator of other cardiovascular disease.
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MESH Headings
- Aged
- Blood Pressure
- Comorbidity
- Echocardiography
- Female
- Humans
- Hypertension, Pulmonary/diagnostic imaging
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/therapy
- Length of Stay
- Logistic Models
- Lung/physiopathology
- Male
- Middle Aged
- Patient Admission
- Predictive Value of Tests
- Pulmonary Disease, Chronic Obstructive/diagnostic imaging
- Pulmonary Disease, Chronic Obstructive/mortality
- Pulmonary Disease, Chronic Obstructive/physiopathology
- Pulmonary Disease, Chronic Obstructive/therapy
- Respiration, Artificial
- Respiratory Function Tests
- Retrospective Studies
- Rhode Island/epidemiology
- Risk Assessment
- Risk Factors
- Survival Analysis
- Survival Rate
- Time Factors
- Treatment Outcome
- Ventricular Function, Right
- Ventricular Pressure
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Affiliation(s)
- Andrew C Stone
- Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital, Providence, RI 02903, USA
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25
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Pandey AK, Wilcox P, Mayo JR, Sin D, Moss R, Ellis J, Brown J, Leipsic J. Predictors of pulmonary hypertension on high-resolution computed tomography of the chest in systemic sclerosis: a retrospective analysis. Can Assoc Radiol J 2010; 61:291-6. [PMID: 20382500 DOI: 10.1016/j.carj.2010.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 02/11/2010] [Accepted: 02/12/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the imaging features on high-resolution computed tomography (HRCT) of the chest and the clinical parameters that are associated with pulmonary hypertension in systemic sclerosis. We specifically investigated whether main pulmonary artery (MPA) diameter and burden of lung fibrosis are predictors of pulmonary hypertension in these patients. METHODS We retrospectively retrieved the database information of patients with systemic sclerosis seen at our hospital between January 2007 and December 2008. A total of 75 patients had HRCT of the chest, pulmonary function testing (PFT), and echocardiography within 6 months of each other. The echocardiography images were reviewed by a level-3 echocardiographer, and 29 cases were excluded because of suboptimal evaluation of pulmonary artery (PA) pressure. Peak PA pressures and PFT of the remaining 46 cases (43 women and 3 men) were charted. The PFT included total lung capacity (TLC), diffusion capacity of lung for carbon monooxide (DLCO) and the ratio of forced expiratory volume in one second and forced vital capacity (FEV1/FVC). The HRCT of the chest of each patient was read by a chest radiologist. The extent of ground glass, reticulation, and honeycombing was objectively scored. The maximum diameter of the main pulmonary artery (MPAD) and ascending aorta were measured. The ratio of main pulmonary artery diameter and ascending aortic diameter (MPAD/AD) and ratio of main pulmonary artery diameter and body surface area (MPAD/BSA) were also calculated. RESULTS Statistical analysis done by using a multivariate model showed that the calculated fibrotic score strongly correlated with peak PA pressures (P < .001). MPAD (P = .0175), and the ratio MPAD/AD (P = .0102) also showed a statistically significant correlation with peak PA pressures. By using stepwise regression analysis, the fibrotic score was found to be the most reliable independent predictor of pulmonary hypertension. CONCLUSION HRCT-determined severity and extent of pulmonary fibrosis may be helpful in screening for pulmonary hypertension in patients with systemic sclerosis.
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Affiliation(s)
- Anoop Kumar Pandey
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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26
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Elwing J, Panos RJ. Pulmonary hypertension associated with COPD. Int J Chron Obstruct Pulmon Dis 2008; 3:55-70. [PMID: 18488429 PMCID: PMC2528217 DOI: 10.2147/copd.s1170] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although the prevalence of pulmonary hypertension (PH) in individuals with chronic obstructive pulmonary disease (COPD) is not known precisely, approximately 10%–30% of patients with moderate to severe COPD have elevated pulmonary pressures. The vast majority of PH associated with COPD is mild to moderate and severe PH occurs in <5% of patients. When COPD is associated with PH, both mortality and morbidity are increased. There are no clinical or physical examination findings that accurately identify patients with underlying PH. Radiographic imaging findings are specific but not sensitive indicators of PH. Echocardiography is the principle noninvasive diagnostic test but may be technically limited in a significant proportion of patients with COPD. Right heart catheterization is required for accurate measurement of pulmonary pressures. The combined effects of inflammation, endothelial cell dysfunction, and angiogenesis appear to contribute to the development of PH associated with COPD. Systemic vasodilators have not been found to be effective therapy. Selective pulmonary vasodilators including inhaled nitric oxide and phosphodiesterase inhibitors are promising treatments for patients with COPD associated PH but further evaluation of these medications is needed prior to their routine use.
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Affiliation(s)
- Jean Elwing
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, University of Cincinnati Medical School, Cincinnati, OH, USA
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27
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Chen HM, Duan YY, Li J, Zhou N, Yuan LJ, Cao TS, Hou W, Zhang HX, Cao W, Yang YH. A rabbit model with acute thrombo-embolic pulmonary hypertension created with echocardiography guidance. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:221-227. [PMID: 17964064 DOI: 10.1016/j.ultrasmedbio.2007.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 05/23/2007] [Accepted: 06/10/2007] [Indexed: 05/25/2023]
Abstract
A rabbit model of acute thrombo-embolic pulmonary hypertension was developed by infusing self-thrombi into the right femoral vein and simultaneously measuring the pulmonary artery pressure via a right heart catheter and echocardiography. The model was used to explore the usefulness of an ultrasound-guided protocol. In the present study, acute thrombo-embolic pulmonary hypertension was produced in 25 of 30 healthy New Zealand rabbits; the success rate was 83%. A significant and positive correlation between the right ventricle-right atrial pressure gradient, an estimate of the pulmonary artery systolic pressure derived from tricuspid regurgitation and the pulmonary artery systolic pressure measured using the right heart catheter (r=0.765, P=0.002) was noted. During the process of establishing a rabbit model of acute thrombo-embolic pulmonary hypertension, it was demonstrated that echocardiography can be used to guide the right heart catheter to obtain pulmonary artery systolic pressure measurements, to quantify the tricuspid regurgitation jet to assess the pulmonary artery systolic pressure and to observe cardiac morphologic changes so as to evaluate cardiac function. Based on the present study, it is clear that echocardiography is valuable in improving the success rate of producing the animal model of acute thrombo-embolic pulmonary hypertension. This could ultimately facilitate preclinical research and clinical research in humans.
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Affiliation(s)
- Hong-mao Chen
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
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28
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Kim SR, Choe YH, Lee KY, Min KH, Park SJ, Lee HB, Lee YC, Rhee YK. Elevated C-reactive Protein Levels are a Sign of Pulmonary Arterial Hypertension in AECOPD. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- So Ri Kim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Airway Remodeling Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Yeong Hun Choe
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Airway Remodeling Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Ka Young Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Airway Remodeling Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Hoon Min
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Airway Remodeling Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Seoung Ju Park
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Airway Remodeling Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Heung Bum Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Yong Chul Lee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Airway Remodeling Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Yang Keun Rhee
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
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29
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Cazzola M, Mantero A, Santus P, Carlucci P, Mondoni M, Bosotti L, Centanni S. Doppler echocardiographic assessment of the effects of inhaled long-acting β2-agonists on pulmonary artery pressure in COPD patients. Pulm Pharmacol Ther 2007; 20:258-64. [PMID: 16600647 DOI: 10.1016/j.pupt.2006.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 02/12/2006] [Indexed: 11/20/2022]
Abstract
Increase in pulmonary artery pressure (PAP), which is common in severe chronic obstructive pulmonary disease (COPD), is a predictor of mortality independent of airflow limitation. beta-agonists might slightly attenuate this increase because they exert a vasodilating effect on pulmonary circulation when systematically administered. We have investigated the acute effects of salmeterol and formoterol on echocardiographic systolic pulmonary artery pressure (sPAP) in 20 patients with COPD and a sPAP greater than 20mmHg at rest. Acute haemodynamic responses to inhaled formoterol or salmeterol were assessed in all patients, in a randomized, double-blind double-dummy fashion. On two consecutive days, patients received, in a randomized order, formoterol 12microg via Turbuhaler plus placebo via Diskus or salmeterol 50microg via Diskus plus placebo via Turbuhaler. Transthoracic Doppler echocardiography measurements of sPAP were made before and 15, 30, 60 and 180min after bronchodilator inhalation. Lung function, pulse oximetry and heart rate were also monitored at the same times. Mean sPAP significantly (p<0.05) decreased in comparison with baseline at 15, 30, and 60min post inhalation but returned towards control levels at 180min after both salmeterol and formoterol. There was no correlation between the maximum increase in FEV(1) and maximum decrease in sPAP either after inhalation of salmeterol (r(2)=0.071) or after that of formoterol (r(2)=0.0006). The increases in FEV(1) in comparison with baseline were always significant (p<0.05) from 15 to 180min post inhalation after either salmeterol or formoterol. Neither pulse oximetry nor heart rate changed in a significant manner (p>0.05). This study demonstrated that salmeterol and formoterol were equally beneficial for pulmonary haemodynamics in patients with COPD. A direct vasodilatation due to the activation of beta-adrenoceptors that are present in pulmonary vessels is a likely mechanism of their action in inducing the decrease in sPAP.
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Affiliation(s)
- Mario Cazzola
- Unit of Pneumology and Allergology, A. Cardarelli Hospital, Via del Parco Margherita 24, 80121 Napoli, Italy.
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30
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31
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32
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Morrell NW, Higham MA, Phillips PG, Shakur BH, Robinson PJ, Beddoes RJ. Pilot study of losartan for pulmonary hypertension in chronic obstructive pulmonary disease. Respir Res 2005; 6:88. [PMID: 16060962 PMCID: PMC1198258 DOI: 10.1186/1465-9921-6-88] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 08/01/2005] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Morbidity in COPD results from a combination of factors including hypoxia-induced pulmonary hypertension, in part due to pulmonary vascular remodelling. Animal studies suggest a role of angiotensin II and acute studies in man concur. Whether chronic angiotensin-II blockade is beneficial is unknown. We studied the effects of an angiotensin-II antagonist losartan, on haemodynamic variables, exercise capacity and symptoms. METHODS This was a double-blind, randomized, parallel group, placebo- controlled study of 48 weeks duration. Forty patients with COPD and pulmonary hypertension (Tran tricuspid pressure gradient (TTPG) = 30 mmHg) were randomised to losartan 50 mg or placebo. Changes in TTPG were assessed at 3, 6 and 12 months. RESULTS There was a trend for TTPG to increase in the placebo group (baseline 43.4 versus 48.4 mmHg at endpoint) and stay constant in the losartan group (baseline 42.8 versus 43.6 mmHg). More patients in the losartan group (50%) than in the placebo group (22%) showed a clinically meaningful reduction in TTPG at any timepoint; these effects seemed more marked in patients with higher baseline TTPG. There were no clear improvements in exercise capacity or symptoms. CONCLUSION In this 12-month pilot study, losartan 50 mg had no statistically significant beneficial effect on TTPG, exercise capacity or symptoms in pulmonary hypertension secondary to obstructive disease. A sub-group of patients with higher TTPG may benefit.
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Affiliation(s)
- Nicholas W Morrell
- Department of Respiratory Medicine, Imperial College School of Medicine, London, UK
| | - Matthew A Higham
- Department of Respiratory Medicine, Imperial College School of Medicine, London, UK
| | - Peter G Phillips
- Department of Respiratory Medicine, Imperial College School of Medicine, London, UK
| | - B Haleema Shakur
- Department of Respiratory Medicine, Imperial College School of Medicine, London, UK
| | - Paul J Robinson
- Medical Department, Merck Sharp & Dohme Limited, Hoddesdon, UK
| | - Ray J Beddoes
- Medical Department, Merck Sharp & Dohme Limited, Hoddesdon, UK
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Yildiz P, Oflaz H, Cine N, Erginel-Unaltuna N, Erzengin F, Yilmaz V. Gene polymorphisms of endothelial nitric oxide synthase enzyme associated with pulmonary hypertension in patients with COPD. Respir Med 2004; 97:1282-8. [PMID: 14682408 DOI: 10.1016/j.rmed.2003.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this cross-sectional controlled study, we aimed to investigate the role of polymorphisms of the angiotensin-converting enzyme (ACE) and endothelial nitric oxide synthase (eNOS) genes on pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD). Forty-two (41 male, 1 female, mean age: 62 +/- 7 years) COPD patients and 40 (all male, mean age: 60 +/- 8 years) healthy controls were included. Respiratory function tests, arterial blood gases, and echocardiographic examinations were performed. ACE and eNOS genotypes were determined using PCR. The ACE and eNOS genotype distribution was not significantly different between COPD patients and controls. On comparing pulmonary artery pressures in different eNOS genotypes, the mean pulmonary artery pressure (Ppa) in patients with the BB genotype was significantly higher than in patients with the nonBB genotypes (41.3 +/- 17.7 mmHg vs. 27.3 +/- 11.2 mmHg, P = 0.02). However, there was no difference in ACE genotype distributions between COPD patients with and without pulmonary hypertension. In stepwise linear regression analysis for predicting pulmonary artery pressure, PaO2 and polymorphism of eNOS gene were found to be independent variables. In conclusion, BB-type polymorphism of the eNOS gene has been associated with PH in addition to hypoxemia. However, ACE gene polymorphism was not found to be associated with PH.
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MESH Headings
- Blood Pressure/physiology
- Cross-Sectional Studies
- Female
- Forced Expiratory Volume/physiology
- Humans
- Hypertension, Pulmonary/enzymology
- Hypertension, Pulmonary/genetics
- Hypertension, Pulmonary/physiopathology
- Hypertrophy, Left Ventricular/enzymology
- Hypertrophy, Left Ventricular/genetics
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Middle Aged
- Nitric Oxide Synthase/genetics
- Nitric Oxide Synthase Type III
- Peptidyl-Dipeptidase A/genetics
- Polymorphism, Genetic
- Pulmonary Disease, Chronic Obstructive/enzymology
- Pulmonary Disease, Chronic Obstructive/genetics
- Pulmonary Disease, Chronic Obstructive/physiopathology
- Vital Capacity/physiology
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Affiliation(s)
- Pinar Yildiz
- Pulmonary Medicine, Yedikule Chest Disease and Chest Surgery Hospital, Istanbul, Turkey.
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LaBan MM, Kucway EJ. Aeolus myth: chronic obstructive lung disease and nocturnal lumbosacral pain in association with lumbar spinal stenosis and pulmonary hypertension. Am J Phys Med Rehabil 2003; 82:660-4. [PMID: 12960906 DOI: 10.1097/01.phm.0000083663.01028.9c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe an association between the syndromes of lumbar spinal stenosis and chronic obstructive pulmonary disease (COPD) in patients presenting with symptoms of nocturnal lumbosacral radiculopathy. DESIGN Retrospective review of 46 sequential inpatients referred with complaints of lumbosacral radicular pain associated with lumbar spinal stenosis. Half (23) were experiencing sleep disruptive nocturnal pain. Each had been hospitalized with a primary diagnosis of COPD. They were subsequently compared with another group of inpatients (23) who were also experiencing lumbar pain not necessarily increased at night. Each was also identified as having lumbar spinal stenosis without an antecedent history of COPD. In each case, lumbar spinal imaging studies (computed tomography or magnetic resonance imaging) were obtained. Pulmonary function tests were performed in those with COPD, and two-dimensional echocardiograms were obtained in all 46 patients. RESULTS The ratio of women to men, their ages, surgical interventions, severity of lumbar spinal stenosis, and left ventricular function as compared one group with another was not significantly different. However, pulmonary artery pressures were notably elevated (i.e., pulmonary hypertension) in those with COPD and nocturnal lumbosacral radiculopathy. CONCLUSION This study suggests that in patients with COPD and lumbar spinal stenosis, pulmonary hypertension may be the dynamic link exacerbating nocturnal lumbosacral pain.
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Affiliation(s)
- Myron M LaBan
- Department of Physical Medicine and Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan 48073, USA
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Yim CF, Lim KS, Low TC. Severe pulmonary hypertension in a patient with bronchiectasis complicated by cor pulmonale and a right-to-left shunt presenting for surgery. Anaesth Intensive Care 2002; 30:467-71. [PMID: 12180586 DOI: 10.1177/0310057x0203000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A patient with advanced bronchiectasis, severe pulmonary hypertension complicated by cor pulmonale and a right-to-left shunt at atrial level presented for sigmoid colectomy. We outline the potential perioperative problems of this situation, discuss the perioperative risks and describe our clinical approach. A total intravenous anaesthetic technique using midazolam, fentanyl, ketamine and rocuronium was used to minimize changes in pulmonary and systemic vascular resistance and not induce bronchospasm. Preoperative nebulized salbutamol and ipratroprium were given to prevent bronchospasm and adrenaline and noradrenaline were infused to maintain cardiac output and the balance between systemic and pulmonary vascular resistance.
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Affiliation(s)
- C F Yim
- Department of Anaesthesia, Alexandra Hospital, Singapore
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