Skip to main content
SpringerLink
Log in

Initial Risk Assessment for Pulmonary Hypertension in Patients with COPD

Lung Aims and scope Submit manuscript

Cite this article

Abstract

Background

Pulmonary hypertension (PH) is a comorbidity associated with increased mortality in chronic obstructive pulmonary disease (COPD) patients. It is not known which clinical markers are predictive of PH in COPD. The goal of this study was to develop a clinical tool to identify patients who should be sent for initial screening with echocardiography.

Methods

Of 127 patients screened, 94 primary-care patients with COPD were enrolled. All underwent full pulmonary function testing, 6-minute walk distance (6MWD), exercise oximetry, Saint George’s Respiratory Questionnaire, and transthoracic echocardiography. Eighty-six patients had measurable pulmonary artery pressures (PAP) on echocardiography. Elevated PAP was defined as a systolic PAP > 35 mmHg.

Results

Pre- and post-bronchodilator FEV1 (P = 0.04 and P = 0.03, respectively), exercise oxyhemoglobin desaturation (P = 0.003), and 6MWD (P = 0.004) were associated with elevated PAP on univariate analysis. Diffusion capacity was lower but did not reach statistical significance (P = 0.07). In multivariate analysis, statistically significant independent variables were >3% decrease in exercise oxyhemoglobin saturation and decline in prebronchodilator FEV1 (P = 0.01 and P = 0.04, respectively). A composite prediction model was developed that assigned one point for each of the following: age > 55 years, oxyhemoglobin desaturation > 3%, prebronchodilator FEV1 < 50% predicted, and 6MWD < 1175 ft. Prevalence rates of elevated PAP were 32% for a score of 0–1 (low risk), 68% for a score of 2 (moderate risk), and 78% for a score of 3–4 (high risk). The composite score exhibited a strong trend with elevated PAP prevalence (Cochrane-Armitage trend statistic P = 0.001).

Conclusion

A simple prediction tool using routine office-based parameters can be used to identify COPD patients at high risk for elevated PAP and initiate the first step in screening for PH with echocardiography. It is important that right heart catheterization be performed to confirm the diagnosis and guide treatment decisions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Barnes PJ, Celli BR (2009) Systemic manifestations and comorbidiites in COPD. Eur Respir J 33:1165–1185

    Article  PubMed  CAS  Google Scholar 

  2. Sin DD, Anthonisen NR, Soriano JB, Agusti AG (2006) Mortality in COPD: role of comorbidities. Eur Respir J 28:1245–1257

    Article  PubMed  CAS  Google Scholar 

  3. Mannino DM, Braman S (2007) The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc 4:502–506

    Article  PubMed  Google Scholar 

  4. Kessler R, Faller M, Fourgaut G et al (1999) Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 159:158–164

    PubMed  CAS  Google Scholar 

  5. Oswald-Mammosser M, Weitzenblum E, Quoix E et al (1995) Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest 107:1193–1198

    Article  PubMed  CAS  Google Scholar 

  6. McGhan R, Radcliff T, Fish R et al (2007) Predictors of rehospitalization and death after a severe exacerbation of COPD. Chest 132:1748–1755

    Article  PubMed  Google Scholar 

  7. Rich JD, Shah SJ, Swamy RS et al (2011) Inaccuracy of doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. Chest 139:988–993

    Article  PubMed  Google Scholar 

  8. Weitzenblum E, Hirth C, Ducolone A et al (1981) Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease. Thorax 36(10):752–758

    Article  PubMed  CAS  Google Scholar 

  9. Weitzenblum E, Sautegeau A, Ehrhart M et al (1984) Long-term course of pulmonary arterial pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis 130:993–998

    PubMed  CAS  Google Scholar 

  10. Oswald-Mammosser M, Oswald T, Nyankiye N et al (1987) Non-invasive diagnosis of pulmonary hypertension in chronic obstructive pulmonary disease. Comparison of ECG, radiological measurement, echocardiography, and myocardial scintigraphy. Eur Respir J 71:419–429

    CAS  Google Scholar 

  11. Oswald-Mammosser M, Apprill M, Bachez P et al (1991) Pulmonary hemodynamics in chronic obstructive pulmonary disease of the emphysematous type. Respiration 58:304–310

    Article  PubMed  CAS  Google Scholar 

  12. Scharf SM, Iqbal M, Keller C et al (2002) Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med 166:314–322

    Article  PubMed  Google Scholar 

  13. Thabut G, Dauriat G, Stern JB et al (2005) Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest 127:1531–1536

    Article  PubMed  Google Scholar 

  14. Doi M, Nakano K, Hiramoto T, Kohno N (2003) Significance of pulmonary artery pressure in emphysema patients with mild-to-moderate hypoxemia. Respir Med 97:915–920

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  16. Miller MR, Crapo R, Hankinson J et al (2005) ATS/ERS task force: standardisation of lung function testing: general considerations for lung function testing. Eur Respir J 26:153–161

    Article  PubMed  CAS  Google Scholar 

  17. Miller MR, Hankinson J, Brusasco V et al (2005) ATS/ERS task force: standardisation of lung function testing: standardisation of spirometry. Eur Respir J 26:319–338

    Article  PubMed  CAS  Google Scholar 

  18. Wanger J, Clausen JL, Coates A et al (2005) ATS/ERS task force: standardisation of lung function testing: standardisation of the measurement of lung volumes. Eur Respir J 26:511–522

    Article  PubMed  CAS  Google Scholar 

  19. Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography. J Am Soc Echocardiogr 23:685–713

    Article  PubMed  Google Scholar 

  20. Jones PW, Quirk FH, Baveystock CM (1991) The St George’s respiratory questionnaire. Respir Med 85(Suppl B):25–31

    Article  PubMed  Google Scholar 

  21. Sims MW, Margolis DJ, Localio AR et al (2009) Impact of pulmonary artery pressure on exercise function in severe COPD. Chest 136:412–419

    Article  PubMed  Google Scholar 

  22. Christensen CC, Ryg MS, Edvardsen A, Skjønsberg OH (2004) Relationship between exercise desaturation and pulmonary haemodynamics in COPD patients. Eur Respir J 24:580–586

    Article  PubMed  CAS  Google Scholar 

  23. Cuttica MJ, Kalhan R, Shlobin OA et al (2010) Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med 104:1877–1882

    Article  PubMed  Google Scholar 

  24. Fayngersh V, Drakopanagiotakis F, McCool FD, Klinger JR (2011) Pulmonary hypertension in a stable community-based COPD population. Lung 189:377–382

    Article  PubMed  Google Scholar 

  25. Criner GJ, Scharf SM, Falk JA et al (2007) Effect of lung volume reduction surgery on resting pulmonary hemodynamics in severe emphysema. Am J Respir Crit Care Med 176:253–260

    Article  PubMed  Google Scholar 

  26. Blanco I, Gimeno E, Munoz PA et al (2010) Hemodynamic and gas exchange effects of sildenafil in patients with COPD and pulmonary hypertension. Am J Respir Crit Care Med 181:270–278

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Gail Dusseault and Laureen Sheehan for their assistance in recruitment and performing the pulmonary function testing.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Divisions of Pulmonary, Critical Care, and Sleep Medicine, Memorial Hospital of Rhode Island, Alpert Medical School of Brown University, 111 Brewster Street, Pawtucket, RI, 02860, USA

    Eric J. Gartman, Michael Blundin & F. Dennis McCool

  2. Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA

    James R. Klinger

  3. Division of Cardiology, Memorial Hospital of Rhode Island, Alpert Medical School of Brown University, Pawtucket, RI, USA

    Joe Yammine

  4. Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Alpert Medical School of Brown University, Pawtucket, RI, USA

    Mary B. Roberts

Authors
  1. Eric J. Gartman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Blundin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James R. Klinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joe Yammine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary B. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Dennis McCool
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric J. Gartman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gartman, E.J., Blundin, M., Klinger, J.R. et al. Initial Risk Assessment for Pulmonary Hypertension in Patients with COPD. Lung 190, 83–89 (2012). https://doi.org/10.1007/s00408-011-9346-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-011-9346-8

Keywords

search

Navigation