Clinical characteristics and prediction of pulmonary hypertension in severe emphysema

Omar A. Minai*, Henry Fessler, James K. Stoller, Gerard J. Criner, Steven M. Scharf, Yvonne Meli, Benjamin Nutter, Malcom McAvoy DeCamp Jr

*Corresponding author for this work

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: We explored the prevalence, clinical and physiologic correlates of pulmonary hypertension (PH), and screening strategies in patients with severe emphysema evaluated for the National Emphysema Treatment Trial (NETT). Methods: Patients undergoing Doppler echocardiography (DE) and right heart catheterization were included. Patients with mean pulmonary arterial pressure ≥25 mmHg (PH Group) were compared to the remainder (non-PH Group). Results: Of 797 patients, 302 (38%) had PH and 18 (2.2%) had severe PH. Compared to the non-PH Group, patients with PH had lower % predicted FEV1 (p < 0.001), % predicted diffusion capacity for carbon monoxide (p = 0.006), and resting room air PaO2 (p < 0.001). By multivariate analysis, elevated right ventricular systolic pressure, reduced resting room air PaO 2, reduced post-bronchodilator % predicted FEV1, and enlarged pulmonary arteries on computed tomographic scan were the best predictors of PH. A strategy using % predicted FEV1, % predicted DLCO, PaO2, and RVSP was predictive of the presence of pre-capillary PH and was highly predictive of its absence. Conclusions: Mildly elevated pulmonary artery pressures are found in a significant proportion of patients with severe emphysema. However, severe PH is uncommon in the absence of co-morbidities. Simple non-invasive tests may be helpful in screening patients for pre-capillary PH in severe emphysema but none is reliably predictive of its presence.

Original languageEnglish (US)
Pages (from-to)482-490
Number of pages9
JournalRespiratory Medicine
Volume108
Issue number3
DOIs
StatePublished - Mar 1 2014

Fingerprint

Emphysema
Pulmonary Hypertension
Pulmonary Artery
Air
Hypertension
Doppler Echocardiography
Bronchodilator Agents
Ventricular Pressure
Carbon Monoxide
Cardiac Catheterization
Arterial Pressure
Multivariate Analysis
Blood Pressure
Morbidity
Pressure
Lung

Keywords

  • Chronic obstructive pulmonary disease
  • Emphysema
  • Hypoxemia
  • Lung disease
  • Pulmonary hypertension

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Minai, O. A., Fessler, H., Stoller, J. K., Criner, G. J., Scharf, S. M., Meli, Y., ... DeCamp Jr, M. M. (2014). Clinical characteristics and prediction of pulmonary hypertension in severe emphysema. Respiratory Medicine, 108(3), 482-490. https://doi.org/10.1016/j.rmed.2013.11.006
Minai, Omar A. ; Fessler, Henry ; Stoller, James K. ; Criner, Gerard J. ; Scharf, Steven M. ; Meli, Yvonne ; Nutter, Benjamin ; DeCamp Jr, Malcom McAvoy. / Clinical characteristics and prediction of pulmonary hypertension in severe emphysema. In: Respiratory Medicine. 2014 ; Vol. 108, No. 3. pp. 482-490.
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Minai, OA, Fessler, H, Stoller, JK, Criner, GJ, Scharf, SM, Meli, Y, Nutter, B & DeCamp Jr, MM 2014, 'Clinical characteristics and prediction of pulmonary hypertension in severe emphysema', Respiratory Medicine, vol. 108, no. 3, pp. 482-490. https://doi.org/10.1016/j.rmed.2013.11.006

Clinical characteristics and prediction of pulmonary hypertension in severe emphysema. / Minai, Omar A.; Fessler, Henry; Stoller, James K.; Criner, Gerard J.; Scharf, Steven M.; Meli, Yvonne; Nutter, Benjamin; DeCamp Jr, Malcom McAvoy.

In: Respiratory Medicine, Vol. 108, No. 3, 01.03.2014, p. 482-490.

Research output: Contribution to journalArticle

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AU - Minai, Omar A.

AU - Fessler, Henry

AU - Stoller, James K.

AU - Criner, Gerard J.

AU - Scharf, Steven M.

AU - Meli, Yvonne

AU - Nutter, Benjamin

AU - DeCamp Jr, Malcom McAvoy

PY - 2014/3/1

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N2 - Background: We explored the prevalence, clinical and physiologic correlates of pulmonary hypertension (PH), and screening strategies in patients with severe emphysema evaluated for the National Emphysema Treatment Trial (NETT). Methods: Patients undergoing Doppler echocardiography (DE) and right heart catheterization were included. Patients with mean pulmonary arterial pressure ≥25 mmHg (PH Group) were compared to the remainder (non-PH Group). Results: Of 797 patients, 302 (38%) had PH and 18 (2.2%) had severe PH. Compared to the non-PH Group, patients with PH had lower % predicted FEV1 (p < 0.001), % predicted diffusion capacity for carbon monoxide (p = 0.006), and resting room air PaO2 (p < 0.001). By multivariate analysis, elevated right ventricular systolic pressure, reduced resting room air PaO 2, reduced post-bronchodilator % predicted FEV1, and enlarged pulmonary arteries on computed tomographic scan were the best predictors of PH. A strategy using % predicted FEV1, % predicted DLCO, PaO2, and RVSP was predictive of the presence of pre-capillary PH and was highly predictive of its absence. Conclusions: Mildly elevated pulmonary artery pressures are found in a significant proportion of patients with severe emphysema. However, severe PH is uncommon in the absence of co-morbidities. Simple non-invasive tests may be helpful in screening patients for pre-capillary PH in severe emphysema but none is reliably predictive of its presence.

AB - Background: We explored the prevalence, clinical and physiologic correlates of pulmonary hypertension (PH), and screening strategies in patients with severe emphysema evaluated for the National Emphysema Treatment Trial (NETT). Methods: Patients undergoing Doppler echocardiography (DE) and right heart catheterization were included. Patients with mean pulmonary arterial pressure ≥25 mmHg (PH Group) were compared to the remainder (non-PH Group). Results: Of 797 patients, 302 (38%) had PH and 18 (2.2%) had severe PH. Compared to the non-PH Group, patients with PH had lower % predicted FEV1 (p < 0.001), % predicted diffusion capacity for carbon monoxide (p = 0.006), and resting room air PaO2 (p < 0.001). By multivariate analysis, elevated right ventricular systolic pressure, reduced resting room air PaO 2, reduced post-bronchodilator % predicted FEV1, and enlarged pulmonary arteries on computed tomographic scan were the best predictors of PH. A strategy using % predicted FEV1, % predicted DLCO, PaO2, and RVSP was predictive of the presence of pre-capillary PH and was highly predictive of its absence. Conclusions: Mildly elevated pulmonary artery pressures are found in a significant proportion of patients with severe emphysema. However, severe PH is uncommon in the absence of co-morbidities. Simple non-invasive tests may be helpful in screening patients for pre-capillary PH in severe emphysema but none is reliably predictive of its presence.

KW - Chronic obstructive pulmonary disease

KW - Emphysema

KW - Hypoxemia

KW - Lung disease

KW - Pulmonary hypertension

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Minai OA, Fessler H, Stoller JK, Criner GJ, Scharf SM, Meli Y et al. Clinical characteristics and prediction of pulmonary hypertension in severe emphysema. Respiratory Medicine. 2014 Mar 1;108(3):482-490. https://doi.org/10.1016/j.rmed.2013.11.006