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Prevalence of Pulmonary Hypertension in Patients with Idiopathic Pulmonary Fibrosis: Correlation with Physiological Parameters

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Abstract

The aim of this study was to prospectively evaluate the prevalence of pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF). One hundred thirty-nine patients (101 male, mean age = 68.6 ± 9 years), with confirmed IPF and who were admitted to eight Pulmonary Departments in Greece between November 2005 and December 2006 were included in the study. Pulmonary artery systolic pressure (PASP) was estimated by echocardiography, and PH was defined as PASP > 36 mmHg. We compared demographics, pulmonary function tests, NYHA functional status, 6-min walk distance (6MWD), B-type natriuretic peptide (BNP), PaO2, and P(A-a)O2 at rest data between patients with PH and without PH (PASP ≤ 36 mmHg). Increased estimated right ventricular systolic pressure was present in 55% of patients (mean PASP = 47.1 ± 11.2 mmHg vs. 30.3 ± 3.8 mmHg, respectively). Patients with PH had a lower but not statistically significant DLCO (47.1 ± 18.8 vs. 52.5 ± 20.1), lower PaO2 at rest (64.6 ± 12.2 vs. 71.1 ± 11.3, P = 0.004), and lower mean 6MWD (282 ± 118 vs. 338 ± 91, P = 0.007). Significant differences were also observed in the NYHA functional status between the two groups (P = 0.02). Statistically significant correlations were observed between PASP and PaO2 at rest (r = −0.331, P = 0.00), P(A-a)O2 at rest (r = 0.494, P = 0.00), 6MWD (r = −0.264, P = 0.01), SpO2 at rest (r = −0.293, P = 0.00), SpO2 at the end of exercise (r = −0.364, P = 0.00), and also BNP values (r = 0.319, P = 0.01). Moreover, PaO2 (P = 0.02), P(A-a)O2 (P = 0.005), and SpO2 at the end of exercise (P = 0.023) were independent predictors of the presence of estimated PH. Using Doppler echocardiography as a screening tool for the estimation of PH, we found that PH is common in patients with IPF. Gas exchange parameters at rest and exercise desaturation might indicate underlying PH in IPF.

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Abbreviations

PH:

Pulmonary hypertension

IPF:

Idiopathic pulmonary fibrosis

RHC:

Right heart catheterization

TTE:

Transthoracic echocardiography

PFTs:

Pulmonary function tests

BNP:

Brain natriuretic peptide

ILD:

Interstitial lung disease

TLC:

Total lung capacity

DLCO :

Diffusing capacity of the lung for carbon monoxide

(A-a)O2 :

Alveolar-arterial oxygen gradient

6-MWT:

6-min walk test

6-MWD:

6-min walk distance

SpO2 :

Resting room air pulse oximetry

2D:

Two-dimensional imaging

PASP:

Pulmonary artery systolic pressure

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Acknowledgments

We acknowledge the contribution of the following colleagues, pulmonologists, and cardiologists who made this report possible: K. Manika, L. Sichletidis, P. Argyropoulou, I. Stanopoulos (Aristotle University of Thessaloniki G. Papanikolaou Hospital, Thessaloniki); Ch. Karvounis (AHEPA University Hospital, Thessaloniki); E. Zakinthynos, K. Gourgoulianis (University of Thessaly, Larissa); R. Triggidou, O. Anagnostopoulou (“SOTIRIA,” Athens Chest Hospital); S. Kakouros (Amalia Fleming Hospital, Athens); P. Nicolakeas (Social Insurance Institute, Athens); F. Kokkinis (Lamia Hospital); E. Gialafos (Laikon Hospital, Athens); A. Patrianakos, E. Lambiri, N. Siafakas (University Hospital of Heraklion); S. Konstantinidis (Democritus University of Thrace, Alexandroupolis); P. Korkonikitas (Agia Olga Hospital, Athens); N. Galanis, (1st Department of Pneumonology, G. Papanikolaou Hospital, Thessaloniki); K. Hainis (Pulmonary Department, Corfu General Hospital). We also thank Μs. Hellie Lithoxopoulou for helping us prepare the manuscript.

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Authors and Affiliations

  1. Department of Pneumonology, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Exochi, 57010, Thessaloniki, Greece

    D. Papakosta, G. Pitsiou & T. Kontakiotis

  2. Department of Pneumonology, University of Thessaly, Larissa, Greece

    Z. Daniil

  3. 1st Department of Pneumonology, “SOTIRIA” Athens Chest Hospital, Athens, Greece

    M. Dimadi

  4. 3rd Department of Pneumonology, “Sismanoglion” General District Hospital, Athens, Greece

    E. Stagaki & V. Polychronopoulos

  5. 8th Department of Pneumonology, “SOTIRIA” Athens Chest Hospital, Athens, Greece

    A. Rapti

  6. Department of Pneumonology, University of Crete, Heraklion, Greece

    K. Antoniou

  7. Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece

    A. Tzouvelekis & D. Bouros

  8. 1st Department of Pneumonology, G. Papanikolaou Hospital, Thessaloniki, Greece

    S. Tryfon

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  1. D. Papakosta
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  2. G. Pitsiou
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  8. A. Tzouvelekis
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  9. T. Kontakiotis
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  11. V. Polychronopoulos
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  12. D. Bouros
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Corresponding author

Correspondence to D. Papakosta.

Additional information

This study is conducted on behalf of the Hellenic ILD Group.

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Papakosta, D., Pitsiou, G., Daniil, Z. et al. Prevalence of Pulmonary Hypertension in Patients with Idiopathic Pulmonary Fibrosis: Correlation with Physiological Parameters. Lung 189, 391–399 (2011). https://doi.org/10.1007/s00408-011-9304-5

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  • DOI: https://doi.org/10.1007/s00408-011-9304-5

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