TY - JOUR
T1 - Categorization and impact of pulmonary hypertension in patients with advanced COPD
AU - Cuttica, Michael J.
AU - Kalhan, Ravi
AU - Shlobin, Oksana A.
AU - Ahmad, Shahzad
AU - Gladwin, Mark
AU - MacHado, Roberto F.
AU - Barnett, Scott D.
AU - Nathan, Steven D.
N1 - Funding Information:
This manuscript is based on OPTN data obtained between 1997 and 2006. The authors thank Katarina Anderson, SAS Analyst from OPTN for her support in data acquisition. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C . The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
PY - 2010/12
Y1 - 2010/12
N2 - Introduction: The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant. Methods: A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed. Results: 4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4%, with pulmonary venous hypertension (PVH) accounting for an additional 17.2% of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = -1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = -1.91; p < 0.001). Both PH (HR 1.23 95%CI [1.01-1.50]) and PVH (HR 1.35 95%CI [1.11-1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95%CI [1.04-1.55], PVH: HR 1.40; 95%CI [1.13-1.73]). Conclusion: PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.
AB - Introduction: The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant. Methods: A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed. Results: 4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4%, with pulmonary venous hypertension (PVH) accounting for an additional 17.2% of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = -1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = -1.91; p < 0.001). Both PH (HR 1.23 95%CI [1.01-1.50]) and PVH (HR 1.35 95%CI [1.11-1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95%CI [1.04-1.55], PVH: HR 1.40; 95%CI [1.13-1.73]). Conclusion: PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.
KW - Chronic obstructive pulmonary disease
KW - Functional status
KW - Prevalence
KW - Pulmonary hypertension
KW - Six minute walk test
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U2 - 10.1016/j.rmed.2010.05.009
DO - 10.1016/j.rmed.2010.05.009
M3 - Article
C2 - 20547449
AN - SCOPUS:78650012669
VL - 104
SP - 1877
EP - 1882
JO - Respiratory Medicine
JF - Respiratory Medicine
SN - 0954-6111
IS - 12
ER -