Omar A Minai1, Henry Fessler2, James K Stoller3, Gerard J Criner4, Steven M Scharf5, Yvonne Meli6, Benjamin Nutter7, Malcolm M DeCamp8. 1. Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, USA. Electronic address: minaio@ccf.org. 2. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, USA. Electronic address: hfessler@jhmi.edu. 3. Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, USA. Electronic address: stollej@ccf.org. 4. Division of Pulmonary and Critical Care Medicine, Temple University, USA. Electronic address: Gerard.Criner@tuhs.temple.edu. 5. Division of Pulmonary and Critical Care Medicine, University of Maryland, USA. Electronic address: sscharf@medicine.umaryland.edu. 6. Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, USA. Electronic address: meliy@ccf.org. 7. Department of Quantitative Health Sciences, Cleveland Clinic, USA. Electronic address: nutteb@ccf.org. 8. Division of Thoracic Surgery, Northwestern University, USA. Electronic address: mdecamp@nmh.org.
Abstract
BACKGROUND: We explored the prevalence, clinical and physiologic correlates of pulmonary hypertension (PH), and screening strategies in patients with severe emphysema evaluated for the National Emphysema Treatment Trial (NETT). METHODS: Patients undergoing Doppler echocardiography (DE) and right heart catheterization were included. Patients with mean pulmonary arterial pressure ≥ 25 mmHg (PH Group) were compared to the remainder (non-PH Group). RESULTS: Of 797 patients, 302 (38%) had PH and 18 (2.2%) had severe PH. Compared to the non-PH Group, patients with PH had lower % predicted FEV1 (p < 0.001), % predicted diffusion capacity for carbon monoxide (p = 0.006), and resting room air PaO2 (p < 0.001). By multivariate analysis, elevated right ventricular systolic pressure, reduced resting room air PaO2, reduced post-bronchodilator % predicted FEV1, and enlarged pulmonary arteries on computed tomographic scan were the best predictors of PH. A strategy using % predicted FEV1, % predicted DLCO, PaO2, and RVSP was predictive of the presence of pre-capillary PH and was highly predictive of its absence. CONCLUSIONS: Mildly elevated pulmonary artery pressures are found in a significant proportion of patients with severe emphysema. However, severe PH is uncommon in the absence of co-morbidities. Simple non-invasive tests may be helpful in screening patients for pre-capillary PH in severe emphysema but none is reliably predictive of its presence.
BACKGROUND: We explored the prevalence, clinical and physiologic correlates of pulmonary hypertension (PH), and screening strategies in patients with severe emphysema evaluated for the National Emphysema Treatment Trial (NETT). METHODS:Patients undergoing Doppler echocardiography (DE) and right heart catheterization were included. Patients with mean pulmonary arterial pressure ≥ 25 mmHg (PH Group) were compared to the remainder (non-PH Group). RESULTS: Of 797 patients, 302 (38%) had PH and 18 (2.2%) had severe PH. Compared to the non-PH Group, patients with PH had lower % predicted FEV1 (p < 0.001), % predicted diffusion capacity for carbon monoxide (p = 0.006), and resting room air PaO2 (p < 0.001). By multivariate analysis, elevated right ventricular systolic pressure, reduced resting room air PaO2, reduced post-bronchodilator % predicted FEV1, and enlarged pulmonary arteries on computed tomographic scan were the best predictors of PH. A strategy using % predicted FEV1, % predicted DLCO, PaO2, and RVSP was predictive of the presence of pre-capillary PH and was highly predictive of its absence. CONCLUSIONS: Mildly elevated pulmonary artery pressures are found in a significant proportion of patients with severe emphysema. However, severe PH is uncommon in the absence of co-morbidities. Simple non-invasive tests may be helpful in screening patients for pre-capillary PH in severe emphysema but none is reliably predictive of its presence.
Authors: Aparna Balasubramanian; Todd M Kolb; Rachel L Damico; Paul M Hassoun; Meredith C McCormack; Stephen C Mathai Journal: Chest Date: 2020-03-14 Impact factor: 9.410
Authors: Carolina S G Freitas; Bruno G Baldi; Carlos Jardim; Mariana S Araujo; Juliana Barbosa Sobral; Gláucia I Heiden; Ronaldo A Kairalla; Rogério Souza; Carlos R R Carvalho Journal: Orphanet J Rare Dis Date: 2017-04-20 Impact factor: 4.123
Authors: Firdaus A Mohamed Hoesein; Tim Besselink; Esther Pompe; Erik-Jan Oudijk; Ed A de Graaf; J M Kwakkel-van Erp; Pim A de Jong; Bart Luijk Journal: Lung Date: 2016-07-16 Impact factor: 2.584