jsmc-10184

NON INVASIVE DIAGNOSIS AND ASSESSMENT OF THE SEVERITY OF PULMONARY HYPERTENSION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Kosar M. Ali a, Shirwan H. Omer b and Razhan Y. Abdalla c

a Department of Medicine, College of Medicine, University of Sulaimani.

b Department of Physiology, College of Medicine, University of Sulaimani.

c General Health Directory of Sulaimani

Submitted: 12/12/2018; Accepted: 20/1/2019; Published 21/3/2019

DOI Link: https://doi.org/10.17656/jsmc.10184 

ABSTRACT

Background 

Pulmonary hypertension (PH) is a common complication of advanced chronic obstructive pulmonary disease (COPD) and is defined by a mean pulmonary artery pressure (PAP) ≥ 25 mm Hg, Pulmonary vascular remodeling in COPD is the main cause of increase in pulmonary artery pressure and is thought to result from the combined effects of hypoxia, inflammation and loss of capillaries in severe emphysema. There is a paucity of worldwide data on prevalence and incidence of PH in COPD. There are also wide variations in the reported prevalence rates in the few studies that have been carried out. This is largely due to the definition of PH and the method of measurement of PAPs. The diagnosis of PH relies on Doppler echocardiography, and right heart catheterization is needed in a minority of patients. 

Objectives 

This cross-sectional study involved 60 patients with COPD. The entire subjects met certain inclusion and exclusion criteria to exclude other possible contributing factors of pulmonary hypertension. All subjects completed a questionnaire, after clinical examination and investigations, the diagnosis of COPD made by a Specialist Physicians in the hospital and Echocardiography was performed by a cardiologist.

Results

The mean age of included patients was 67.1±11.2 years; males were more than females with male to female ratio as 2.75:1, among study sample (48.4%) COPD patients were current smokers, with mean of 54±29 packs/year, mean Spo2 of COPD patients was 89.7±6 %. The Gold staging of COPD patients was distributed as followings; stage I (25%), stage II (33.3%), stage III (21.7%) and stage IV (20%), Pulmonary hypertension (PH) as diagnosed by echocardiography was present among 66.7% of COPD patients. Prevalence of pulmonary hypertension among COPD patients in our study was 66.7%. And pulmonary hypertension severity was distributed as followings; mild (37.5%), moderate (32.5%) and severe (30%). Right ventricular hypertrophy was present among 31.7% of COPD patients. 

Conclusion

High incidence of pulmonary hypertension among patients with chronic obstructive pulmonary diseases, pulmonary hypertension severity is related with the severity of chronic obstructive pulmonary diseases and Echocardiography is useful and effective tool for detection of pulmonary hypertension secondary to chronic obstructive pulmonary disease.

KEYWORDS

Chronic Obstructive pulmonary disease, Pulmonary Hypertension, Echocardiography.

References 

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). (Global Strategy for the Diagnosis, Management and Prevention of COPD (2017). Retrieved from http://www.goldcopd.org.

2. Thabut G, Dauriat G, Stern JB, Logeart D, Lévy A, Marrash Chahla R, Mal H. Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest 2005; 127(5):1531-1536.

3. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23: 932–946.

4. Han MK, McLaughlin VV, Criner GJ, Martinez FJ. Pulmonary diseases and the heart. Circulation 2007;116:2992- 3005.

5. Hoeper MM. The new definition of pulmonary hypertension. Eur Respir J 2009; 34: 790–791

6. Barberà JA, Blanco I. Pulmonary hypertension in patients with chronic obstructive pulmonary disease, advances in pathophysiology and management. Drugs 2009; 69(9):1153-1171. 

7. Seeger W, Adir Y, Barbera JA. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013, 62: D109-D116. 

8. Gulmez Oyku. Pulmonary Hypertension in Patients with Chronic Obstructive Pulmonary Disease: A Review for Definition, Epidemiology, Pathology, and Diagnosis. Gen Med (Los Angeles) 2017, 5:4, DOI: 10.4172/2327-5146.1000293.

9.Minai OA, Fessler H, Stoller JK, Criner GJ, Scharf SM, et al. Clinical characteristics and prediction of pulmonary hypertension in severe emphysema. Respir Med, (2014); 108: 482-490. 

10. Wrobel JP, Thompson BR, Williams TJ.Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: A pathophysiologic review. J Heart Lung Transplant 31: 557-564 

11. Simonneau G, Galie N, Rubin LJ, Langleben D, Seeger W, Domenighetti G, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004; 43(12): 5S-12S.

12. Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis, 2014. 9: 871-888.

13. Chaouat A, Bugnet AS, Kadaoui N, Schott R, Enache I, et al. Severe pulmonary hypertension and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005. 172: 189-194. 

14. Elwing J, Panos RJ. Pulmonary hypertension associated with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2008; 3(1):55-70.

15. Kessler R, Faller M, Weitzenblum E. “Natural history” of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease. Am J Respir Crit Care Med. 2001; 164:219–224.

16. Eddahibi S, Chaouat A, Morrell N. Polymorphism of the serotonin transporter gene and pulmonary hypertension in chronic obstructive pulmonary disease Circulation. 2003; 108:1839–1844.

17. Wrobel JP, Thompson BR, Williams TJ. Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: A pathophysiologic review. J Heart Lung Transplant. 2012; 31: 557-564 

18. Gologanu, D. A, Stanescu, N. A., & Bogdan, M. A. Pulmonary hypertension secondary to chronic obstructive pulmonary disease. Romanian journal of internal medicine= Revue roumaine de medecine interne. 2012, 50(4), 259-268.

19. Groves, B. M.., & Badesch, D. B. Cardiac catheterization of patients with pulmonary hypertension.1996, In A. J. Peacock (Ed.), Pulmonary circulation. London: Chapman Hall: 51 – 67.

20. Leuchte HH, Baumgartner RA, Nounou ME. Brain natriuretic peptide is a prognostic parameter in chronic lung disease. Am J Respir Crit Care Med. 2006; 173: 744–750.

21. Arcasoy SM, Christie JD, Ferrari VA, Sutton MS, Zisman DA, Blumenthal NP, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med. 2003;167:735-40. 

22. Fisher M, Forfia P, Chamera E, Housten-Harris T, Champion HC, Girgis RE, et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009;179:615-21. 

23. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barberà JA, et al; Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2009; 34(6):1219-1263.

24. Galiè N, Humbert M, Vachiery JL. ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37: 67-119.

25. Reilly, J. J., Silverman, E. K., & Shapiro, S. D. Chronic obstructive pulmonary disease. In: Loscalazo J, Fauci AS, Kasper DL, et al. (Eds.), Harrison’s Pulmonary and Critical Care Medicine. 2013; (2nd ed., p. 178). McGraw-Hill.

26. Ozben, B. E, Eryuksel, E., Tanrikulu, A. M., Papila, N., Ozyigit, T., Celikel, T., & Basaran, Y. Acute exacerbation impairs right ventricular function in COPD patients. Hellenic J Cardiol, 2015; 56, 324-331.

27. Soliman, M., Heshmat, H., Amen, Y., Aboelhassan, U. E., & Mahmod, K. Detection of right sided heart changes and pulmonary hypertension in COPD patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2015; 64(2), 335-341.

28. Forfia, P. R., Fisher, M. R., Mathai, S. C., Housten-Harris, T., Hemnes, A. R., Borlaug, B. A., ... & Girgis, R. E. Tricuspid annular displacement predicts survival in pulmonary hypertension. American journal of respiratory and critical care medicine. 2006; 174(9), 1034-1041.

29. Gartman, E. J., Blundin, M., Klinger, J. R., Yammine, J., Roberts, M. B., & McCool, F. D. Initial risk assessment for pulmonary hypertension in patients with COPD. Lung. 2012; 190(1), 83-89.

30. Fayngersh, V., Drakopanagiotakis, F., McCool, F. D., & Klinger, J. R. Pulmonary hypertension in a stable community-based COPD population. Lung. 2011; 189(5), 377.

31. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2013. Available from: goldcopd.org.

32. Berra G, Noble S, Soccal P-M. Pulmonary hypertension in the elderly: a different disease. Breathe. 2016; 12: 43–49.

33. Gologanu D, Stanescu C, Ursica T, Balea MI, Ionita D, Bogdan MA. Prevalence and Characteristics of Pulmonary Hypertension Associated with COPD - A Pilot Study in Patients Referred to a Pulmonary Rehabilitation Program Clinic. Mædica. 2013; 8(3):243-248.

34. Mahishale V, Patil B, Rathi A, Sindhuri A, Eti A. Screening of Chronic Obstructive Pulmonary Disease Patients for Pulmonary Arterial Hypertension Using Two-Dimensional Transthoracic Doppler Echocardiography in Tertiary Care Hospital in India. Heart India. 2015; 3 (3): 66-71.

35. Shujaat A, Bajwa AA, Cury JD. Pulmonary Hypertension Secondary to COPD. Pulmonary Medicine. 2012, Article ID 203952, page 16.

36. Soliman M, Heshmat h, Amen Y, Aboelhassan UE, Mahmod K. Detection of right sided heart changes and pulmonary hypertension in COPD patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2015; 64 (2): 335–341.

37. Scharf SM, Iqbal M, Keller C, Criner G, Lee S, Fessler HE. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med. 2002; 166(3):314–322.

38. Badesch DB, Champion HC, Sanchez MA. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2009; 54(1):S55–66.

39. Kessler R, Chaouat A, Schinkewitch P. The obesity-hypoventilation syndrome revisited: a prospective study of 34 consecutive cases. Chest. 2001; 120(2):369–376.

40. Higham MA, Dawson D, Joshi J. Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD. Eur Respir J. 2001; 17:350–355.

41.Barberà JA, Peinado VI, Santos S. Pulmonary hypertension in COPD. Eur Respir J. 2003; 21:892–905.

42. Tramarin R, Torbicki A, Marchandise B. Doppler echocardiographic evaluation of pulmonary artery pressure in chronic obstructive pulmonary disease. A European multicentre study. Eur Heart J. 2000; 12:103–111.

43. Hoffmann J, Wilhelm J, Marsh LM, Ghanim B, Klepetko W, et al. Distinct differences in gene expression patterns in pulmonary arteries of patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis with pulmonary hypertension. Am J Respir Crit Care Med. 2014; 190: 98-111.

44. Chaouat A, Minai OA. Pulmonary hypertension in patients with COPD. Eur Respir Monogr. 2012; 57: 138–147.

45. Gupta SS, Gothi D, Narula G, Sircar J. Correlation of BMI and oxygen saturation in stable COPD in Northern India. Lung India : Official Organ of Indian Chest Society 2014; 31(1):29-34. 

46. Khther SA, Ismael DH. Impact of Chronic Obstructive Pulmonary Disease on Psychological Aspects of Patients Quality of Life in Erbil City. Kufa Journal for Nursing Sciences 2015; 5 (1): 1-8.

47. Jamaati HR, Heshmat B, Tamadon R. Association between Severity of Chronic Obstructive Pulmonary Disease and Lung Function Tests. Tanaffos 2013; 12(1):36-41.

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