Chronic obstructive pulmonary disease in patients with chronic thromboembolic pulmonary hypertension: Prevalence and implications for surgical treatment outcome

Abstract

COPD in patients with CTEPH significantly increases the risk of residual pulmonary hypertension, in-hospital mortality and increases the duration of hospital stay after PEA.

Efficacy and Safety of Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension and Comorbid Chronic Obstructive Pulmonary Disease

“… 11 COPD is considered as one of the medical conditions associated with CTEPH; the comorbidity rate of CTEPH in COPD was 0.2%, 11 whereas the comorbidity rate of COPD in CTEPH was 10% to 23% in the international CTEPH registry. 20 , 21 Therefore, factors of Group 4 appear to contribute considerably to PH in patients with CTEPH and concurrent COPD. The treatment algorithm for CTEPH was updated at the 6th World Symposium on PH at Nice, France in 2018; after an assessment by a multidisciplinary CTEPH expert team; patients judged operable undergo pulmonary endarterectomy, patients judged nonoperable are treated with medical therapy with or without BPA.…”

“…In that study, 49 patients (23%) had COPD, and the presence of COPD was a significant negative risk factor for adverse PEA outcomes, including increased risk of complications, prolonged duration of hospitalization, the risk of residual PH, and the risk of in‐hospital mortality in the early postoperative period of PEA. 20 Comorbid respiratory dysfunction can negatively impact the results of surgical intervention, and lead to poor PEA outcomes. Moderate‐to‐severe COPD is one of the causes of nonoperability, even if the type of the organized thrombus is deemed operable.…”

Single-cell RNA-sequencing and microarray analyses to explore the pathological mechanisms of chronic thromboembolic pulmonary hypertension

“…APP was also involved in the circ_0026692-miR-20b-5p- APP and circ_0021630-miR-20b-5p- APP regulatory axes in all four cell types. Moreover, recent evidence has revealed that chronic obstructive pulmonary disease increases the risk of complications and mortality in patients with CTEPH during the early postoperative period after a pulmonary endarterectomy ( 31 ). Taken together, the above data imply that fibroblasts, smooth muscle cells, endothelial cells, and myofibroblasts may be involved in the development of CTEPH via the circ_0026692/circ_0021630–miR-20b-5p– APP regulatory axis.…”

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension in Patients With Chronic Obstructive Pulmonary Disease: A Note of Caution

“…Although surgical pulmonary thromboendarterectomy (PEA) is the preferred approach for patients with CTEPH to reduce pulmonary vascular resistance and improve oxygenation, the presence of COPD has been associated with an increased risk of residual pulmonary hypertension after PEA by an odds ratio of 6.2 and an increased risk of in‐hospital mortality by an odds ratio of 4.4. 2 Moreover, in a National Quality Improvement Program database cohort of 468 795 patients, patients with COPD undergoing PEA had increased morbidity (25.8% versus 10.2%) and increased 30‐day mortality (6.7% versus 1.4%) as compared with patients without COPD. This association was less profound but still present after logistic regression modeling, with odds ratios of 1.35 and 1.29 for morbidity and mortality, respectively, suggesting that COPD was also a marker of other comorbidities associated with perioperative risk.…”

“…This is consistent with a Russian cohort of 136 patients with CTEPH in patients scheduled for elective PEA that reported the incidence of COPD to be 23%. 2 Of note, patients with mild COPD were excluded from this analysis. Although it is difficult to know for sure the causal relationship between ventilatory impairment and vascular obstruction, it is less likely that patients with CTEPH from, for example, a hypercoagulable state, would subsequently develop ventilatory impairments.…”