[Pulmonary hypertension and cor pulmonale in COPD].

The prevalence and natural history of cor pulmonale in COPD are not yet clear. Factors that are known to contribute to the development of pulmonary hypertension in COPD include hypoxic pulmonary vasoconstriction(HPV), remodeling of pulmonary arteries, destruction of the pulmonary capillary bed and polycythemia. In addition, impaired mechanisms of endothelium-dependent vasodilation such as reduced NO synthesis or release, and abnormal secretion of vasoconstrictor peptides play an important role in the development of pulmonary hypertension. These factors can lead to right ventricular hypertrophy and right heart failure. Pulmonary hypertension develops late in the course of COPD (stage III) usually after the development of severe hypoxemia and is associated with a poor prognosis of the disease.