Impact of Pulmonary Artery Pressure on Exercise Function in Severe COPD

Sims, Michael W.; Margolis, David J.; Localio, A. Russell; Panettieri, Reynold A.; Kawut, Steven M.; Christie, Jason D.

doi:10.1378/chest.08-2739

Cited by 106 publications

(91 citation statements)

References 33 publications

(36 reference statements)

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“…Interestingly, although hypoxaemia was adequately corrected by long term oxygen therapy, severe PH persisted. These observations support the hypothesis that hypoxia is not the sole driver of severe PH-COPD [2,33]. There is little data supporting the use of pulmonary vasodilators used in PAH in patients with PH-COPD [34][35][36][37].…”

Section: Discussionmentioning

confidence: 64%

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Pulmonary hypertension in COPD: results from the ASPIRE registry

et al. 2012

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The phenotype and outcome of severe pulmonary hypertension in chronic obstructive pulmonary disease (COPD) is described in small numbers, and predictors of survival are unknown. Data was retrieved for 101 consecutive, treatment-naïve cases of pulmonary hypertension in COPD.Mean¡SD follow-up was 2.3¡1.9 years. 59 patients with COPD and severe pulmonary hypertension, defined by catheter mean pulmonary artery pressure o40 mmHg, had significantly lower carbon monoxide diffusion, less severe airflow obstruction but not significantly different emphysema scores on computed tomography compared to 42 patients with mild-moderate pulmonary hypertension. 1-and 3-year survival for severe pulmonary hypertension, at 70% and 33%, respectively, was inferior to 83% and 55%, respectively, for mild-moderate pulmonary hypertension. Mixed venous oxygen saturation, carbon monoxide diffusion, World Health Organization functional class and age, but not severity of airflow obstruction, were independent predictors of outcome. Compassionate treatment with targeted therapies in 43 patients with severe pulmonary hypertension was not associated with a survival benefit, although improvement in functional class and/or fall in pulmonary vascular resistance .20% following treatment identified patients with improved survival.Standard prognostic markers in COPD have limited value in patients with pulmonary hypertension. This study identifies variables that predict outcome in this phenotype. Despite poor prognosis, our data suggest that further evaluation of targeted therapies is warranted.

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Section: Discussionmentioning

confidence: 64%

“…T he development of pulmonary hypertension (PH) in chronic lung diseases such as chronic obstructive pulmonary disease (COPD) has both functional and prognostic implications [1,2]. PH in COPD (PH-COPD) is usually mild to moderate with preserved cardiac output, and evolves slowly alongside the progression of lung disease and hypoxaemia [3].…”

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confidence: 99%

Pulmonary hypertension in COPD: results from the ASPIRE registry

et al. 2012

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“…Although pulmonary hypertension in COPD is usually of moderate severity, its presence is associated with shorter survival, more frequent exacerbations and an increased use of health resources [3]. While airflow obstruction is the major factor limiting exercise tolerance in COPD, recent data suggest that the presence of pulmonary hypertension might also contribute to exercise impairment [4,5], particularly in those with severe pulmonary hypertension [6]. There is currently no pharmacological treatment for pulmonary hypertension in COPD [7].…”

Section: Introductionmentioning

confidence: 99%

Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial

et al. 2013

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Pulmonary hypertension is a serious complication of chronic obstructive pulmonary disease (COPD) that currently has no established pharmacological treatment. This study aimed to assess whether concomitant treatment with sildenafil would enhance the results of pulmonary rehabilitation in patients with COPD and increased pulmonary arterial pressure (PAP).In this double-blind, randomised controlled trial patients received 20 mg sildenafil or placebo three times daily and underwent pulmonary rehabilitation for 3 months. The primary end-point was the gain in the cycle endurance time at a constant work-rate. Secondary end-points included performance in the incremental exercise test, 6-min walk distance and quality of life.63 patients with severe COPD and moderately increased PAP were randomised. Cycle endurance time increased by 149 s (95% CI 26-518 s) in the sildenafil group and by 169 s (95% CI 0-768 s) in the placebo group (median change difference -7 s, 95% CI -540-244 s; p50.77). Gains in the incremental exercise test, 6-min walk distance and quality of life at the end of the study did not differ between groups. Measurements of arterial oxygenation and adverse events were similar in both groups.In patients with severe COPD and moderately increased PAP, concomitant treatment with sildenafil does not improve the results of pulmonary rehabilitation in exercise tolerance. @ERSpublications Sildenafil did not improve respiratory rehabilitation outcomes in patients with severe COPD and moderately increased PAP

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“…However, pulmonary hypertension is possibly an important comorbidity, which can result from LVSD32, 33, 34 or IPF 35, 36. Whether due to LVSD37, 38 or IPF,39, 40, 41 pulmonary hypertension is associated with significantly increased morbidity and mortality. In addition to the postulated role of pulmonary hypertension, there is evidence demonstrating extensive redistribution of pulmonary blood flow in individuals with hemodynamically significant LVSD, underscoring a complex heart–lung interaction 42.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

Waheed

Chaves

Gardin

et al. 2015

JAHA

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BackgroundImpaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all‐cause mortality, and their impact on risk classification using a continuous net reclassification index.Methods and ResultsWe followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all‐cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5–3.0), 1.7 (1.4–2.1), and 3.2 (2.0–5.1) for HF; 1.8 (1.2–2.6), 1.4 (1.1–1.8), and 2.8 (1.7–4.7) for cardiovascular mortality; 1.3 (1.0–1.8), 1.7 (1.4–1.9), and 2.1 (1.5–3.0) for all‐cause mortality, and 1.6 (1.3–2.1), 1.7 (1.5–1.9), and 2.4 (1.7–3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF.ConclusionsWhile risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.

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Impact of Pulmonary Artery Pressure on Exercise Function in Severe COPD

Cited by 106 publications

References 33 publications

Pulmonary hypertension in COPD: results from the ASPIRE registry

Pulmonary hypertension in COPD: results from the ASPIRE registry

Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

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