Severe Pulmonary Hypertension Associated with COPD: Hemodynamic Improvement with Specific Therapy

Abstract

Background: There is no recommendation for treating pulmonary hypertension (PH) when associated with chronic obstructive pulmonary disease (COPD). Objective: To evaluate the effect of PH-specific therapy in patients with COPD. Methods: All successive patients with severe PH [mean pulmonary arterial pressure (mPAP) ≥35 mm Hg] and COPD, who received specific PH medication and who underwent right heart catheterization at baseline and after 3-12 months of treatment, were analyzed from a prospective database. Results: Twenty-six patients were included with a median follow-up of 14 months. Mean forced expiratory volume in 1 s was 57 ± 20% of predicted, and mean forced expiratory volume in 1 s/forced vital capacity was 47 ± 12%. Dyspnea was New York Health Association classification stage (NYHA) II in 15%, NYHA III in 81% and NYHA IV in 4%. First-line treatments were endothelin receptor antagonists in 11 patients, phosphodiesterase-5 inhibitors in 11 patients, calcium blocker in 1 patient, combination therapy in 3 patients including 2 with a prostanoid. After 6 ± 3 months, pulmonary vascular resistance decreased from 8.5 ± 3 to 6.6 ± 2 Wood units (p < 0.001), with significant improvement of cardiac index from 2.44 ± 0.43 to 2.68 ± 0.63 liters × min × m^-2 (p = 0.015) and mPAP from 48 ± 9 to 42 ± 10 mm Hg (p = 0.008). There was no significant difference in dyspnea, 6-min walking distance, echocardiographic parameters or N-terminal pro-brain natriuretic peptide levels. There was no significant difference in arterial oxygen saturation after 3-12 months of treatment. Conclusions: Specific PH medications may improve hemodynamic parameters in COPD patients with severe PH. Appropriate prospective randomized studies are needed to evaluate the potential long-term clinical benefit of treatment.

Risk of Direct Oral Anticoagulant Bioaccumulation in Patients with Pulmonary Hypertension

“…Despite the absence of a validated indication, some non-PAH patients in our cohort received an off-label PAH-targeted therapy. This trend has also been found in other cohort studies, like the ASPIRE registry [23] or others [32,33,34]. However, it is now clearly stated in the 2015 ESC/ERS guidelines [7] that PAH treatment is not recommended in patients with PH from another group than 1, and now 4 for riociguat.…”

Pulmonary Arterial Hypertension-Specific Drug Therapy in COPD Patients with Severe Pulmonary Hypertension and Mild-to-Moderate Airflow Limitation

“…There are few studies in the literature which evaluated the hemodynamic status of PH-COPD in patients treated with specific PH therapy, and the results are contradictory [10,13,18,19,20,21]. A recent meta-analysis which included 9 randomized controlled trials concerning PH-specific therapy in PH-COPD patients showed an improvement in dyspnea, exercise capacity, and PAP [22].…”

Comparison of Long Term Oxygen-Therapy (LTOT) and LTOT Combined with Sildenafil and Simvastatin in the Treatment of Severe Chronic Obstructive Pulmonary (COPD) with Hypoxia at Rest and Severe Pulmonary Arterial Hypertension

“…Until now, the exact mechanism of sildenafil or other phosphodiesterase-5 (PDE-5) inhibitors on dyspnea status of patients with COPD has not been well demonstrated [21,22]. However, its role in amelioration of dyspnea status in patients with other cardio-respiratory diseases has been described by previous studies [23,24].…”