Combined use of non-invasive techniques to predict pulmonary arterial pressure in chronic respiratory disease.

Abstract

on behal(ofa working group* established by the European Office of the World Health Organisation, Copenhagen ABSTRACT The value of non-invasive procedures for predicting pulmonary arterial pressure was investigated in 370 patients with chronic obstructive lung diseases and in 73 with fibrosing alveolitis in a combined study at nine centres in six European countries. Measurements included forced expiratory volume in one second, arterial blood gas tensions, standard electrocardiogram, radiographic dimensions ofpulmonary artery, right ventricle dimensions by M mode echocardiography, and myocardial scintigraphy with thallium-201; and certain clinical signs were also used. No single variable was correlated closely enough to allow accurate prediction of pulmonary arterial pressure. Four methods were used to incorporate several variables into mathematical functions for predicting pulmonary arterial pressure. In patients with chronic obstructive lung disease multiple stepwise regression explained 49% of the variance in pulmonary arterial pressure but was not useful for prediction. Discriminant analysis allowed patients to be allocated to bands of pulmonary arterial pressure, as did two non-parametric procedures, in which decision trees were established using either the Kolmogoroff-Smirnoff statistic or Fisher's exact test. Patients with a pulmonary arterial pressure of 30 mm Hg or more were identified with a sensitivity of 83% and a specificity of 91%. The nonparametric tests gave better results than discriminant function. A further 54 patients were studied to validate the functions. Of these, 90% with a pulmonary arterial pressure above 20 mm Hg were correctly identified, and 80% of those with a pulmonary arterial pressure above 29 mm Hg. Similar results were obtained in subjects with fibrosing alveolitis. These mathematical functions allow the use of combinations of non-invasive procedures to select from populations at risk of pulmonary hypertension those in whom direct measurement is required. The mathematical functions are capable of further development by incorporation of variables from newer non-invasive procedures.

Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD

“…tests in COPD, a previous study of 33 patients addressed whether pulmonary artery end diastolic pressure estimated echocardiographically correlated with pulmonary function indices and found a correlation with KCO but not Pa,O 2 [26]. A large multicentre study of 370 patients with COPD correlated invasively derived pulmonary arterial pressure with spirometry, but not gas transfer measurements, and obtained a correlation coefficient of -0.28 for FEV1 [5], which is remarkably similar to the value of -0.26 reported in the present study. This lends credence to the accuracy of echocardiographic estimation of pulmonary arterial pressures reported in the present paper.…”

“…Although the true prevalence of PH is unknown, an elevation of pulmonary arterial pressure is reported to occur in 5-40% of patients in series of selected individuals with severe COPD undergoing right heart catheterization [4]. The magnitude of PH measured invasively correlates with indices of airflow obstruction and gas exchange, but the relationship is weak [5]. The degree of PH secondary to COPD is generally considered mild (e.g.…”

Subxiphoid echocardiographic evaluation of right heart function in patients with chronic obstructive pulmonary disease

“…Doppler method of formula estimation of PA pressure using the velocity of tricuspid regurgitation in pulmonary diseases is considered the most convenient one (3). 11,3±2,9 (7,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)8) 13,5±5,1 (6,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)1) 9,6±3,61 (4,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)3) 28,9±3,6 (22-33) Table 5. Echocardiographic results in COPD patients according to cardiac and respiratory status * -p < 0,001; -p < 0,01; -p < 0,02; ∆ -p < 0,05; NS -not significant Controlled AF does not change statistically these parameters in comparison with PH patients.…”

“…Long-term oxygen therapy (14) and potentiating medication (5) may improve the prognosis by reducing pulmonary hypertension. This determines the necessity for noninvasive evaluation of pulmonary hypertension (1) and associated disorders in right ventricular (RV) function. The non-invasive estimation of pulmonary artery (PA) pressures is accompanied by a series of…”

Assessment of Pulmonary Hypertension Exposure to Biomass Smoke in Female Patients

“…Bizim çalışmamızda da biomass maruziyeti olan KOAH'lı kadın olgularda pulmoner hipertansiyon (sPAB 38,3±10,7 mmHg) saptanırken, pulmoner semptomları olmayan olgularda sPAB 32,5±7,6 mmHg idi. İkinci grupta sPAB düşük görünmekle birlikte araların- Yapılan bazı çalışmalarda pulmoner hipertansiyon ile Spirometri değerleri arasında ilişki kurulurken (18,19), FEV 1 ile sPAB arasın-da zayıf ilişki saptayan yada hiç ilişki saptamayan çalışmalar da vardır (20,21 Çıkar Çatışması: Yazarlar çıkar çatışması bildirmemişlerdir.…”