A clinicopathological study of fatal chronic airways obstruction.

Abstract

Scott, K. W. M. (1976). Thorax, 31,[693][694][695][696][697][698][699][700][701]. A clinicopathological study of fatal chronic airways obstruction. A clinicopathological study of 21 patients who died as a result of chronic airways obstruction was carried out. Thirteen patients had been in right ventricular failure for at least one year before death and the other eight patients did not have right ventricular failure. The patients with long-standing right ventricular failure died at a younger age, on average, than those without failure. There were no significant quantitative differences between the two groups in the length of history of chest disease, blood gas estimations, respiratory function tests or degree of polycythaemia. The group with right ventricular failure had significantly larger mean right and left ventricular weights than the group without failure, but there were no significant differences in amounts of emphysema, size of bronchial mucous glands, proportion of small airways lumen in the lung or number of thick-walled peripheral lung vessels between the two groups.The findings did not support the division of this series of patients, with fatal chronic airways obstruction, into two distinct groups broadly defined as 'emphysematous' and 'bronchitic', either clinically or pathologically. A history of right ventricular failure correlated well with the finding of right ventricular hypertrophy at necropsy. Electrocardiographic evidence of right ventricular hypertrophy was found to correspond with the size of the right ventricle at necropsy in 66% of cases. The radiographic diagnosis of emphysema proved an accurate assessment when compared to the necropsy findings, and radiographic estimations of right ventricular enlargement were accurate in 65% of cases.Histological evidence of acute bronchitis was present in 20 of the 21 patients (95%), and five patients showed histological evidence of minor pulmonary thromboembolism. Ten patients in the series showed an increase in the weight of the left ventricle as well as the right ventricle.

Right Ventricular Dysfunction in Chronic Lung Disease

“…Concentric RV hypertrophy can precede resting hypoxia in stable COPD patients 20 , and has been demonstrated at autopsy in 76% of patients with advanced COPD 21 . RV hypertrophy was estimated to be present in 50% of patients with restrictive lung disease 22 .…”

Pulmonary Hyperinflation and Left Ventricular Mass

“…8-10 Early autopsy and ventriculography studies reported increased LV mass and wall thickness in the presence of obstructive lung disease, 11-13 subsequent studies, however, produced conflicting results and none assessed the role of pulmonary hyperinflation. 14-18 …”

A Retrospective Study on the Efficacy of PAH-targeted Therapy in Patients with Severe Pulmonary Hypertension in Chronic Lung Disease

“…On the other hand, in our study, only 5phosphodiesterase inhibitors and prostacyclin analogs were used in patients and both of them may selectively and preferentially expand the pulmonary blood vessels in the lighter lung area. It has been reported [43] that phosphodiesterase 5 inhibitor and inhaled iloprost, treprostinil, or nitric oxide in advanced lung disease may improve patients' arterial oxygenation, DLCO, dyspnea and quality of life because of their mode of distribution. In contrast, other studies have found that endothelin receptor inhibitors can worsen the gas exchange process of patients with lung diseases by changing the sensitivity of the carotid body to hypoxia [44] .…”