RT Journal Article
SR Electronic
T1 Pulmonary hypertension in COPD: results from the ASPIRE registry
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1292
OP 1301
DO 10.1183/09031936.00079512
VO 41
IS 6
A1 Judith Hurdman
A1 Robin Condliffe
A1 Charlie A. Elliot
A1 Andrew Swift
A1 Smitha Rajaram
A1 Christine Davies
A1 Catherine Hill
A1 Neil Hamilton
A1 Iain J. Armstrong
A1 Catherine Billings
A1 Lauren Pollard
A1 Jim M. Wild
A1 Allan Lawrie
A1 Rod Lawson
A1 Ian Sabroe
A1 David G. Kiely
YR 2013
UL http://erj.ersjournals.com/content/41/6/1292.abstract
AB 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 ≥40 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.