Chronic obstructive pulmonary disease and pulmonary hypertension: clinical course, survival and mortality predictors
https://doi.org/10.18093/0869-0189-2017-27-3-357-365
Abstract
The aim of this study was to investigate clinical course, survival and predictors of mortality in patients with chronic obstructive pulmonary disease (COPD) with or without pulmonary hypertension (PH). Methods. The study involved 288 patients with COPD (276 males, 12 females; mean age, 59.50 ± 9.27 years; smoking history, 23.10 ± 11.42 pack-years; body mass index, 27.20 ± 12.06 kg × m-2; the annual exacerbation rate, 2.40 ± 0.89), GOLD stage, II – IV (GOLD, 2016). PH was diagnosed if resting systolic pulmonary artery pressure (sysPAP) measured by Doppler echocardiography was > 40 mm Hg. The patients were divided on three groups: those without PH (sysPAP < 40 mm Hg; n = 168), those with moderate PH (sysPAP, 40 – 55 mm Hg; n = 101), and those with severe PH (sysPAP > 55 mm Hg; n = 19). Results. Increased sysPAP was found in 120 patients (41.7%) including 101 patients with moderate PH (35.1%) and 19 patients with severe PH (6.6%). Clinical symptoms of PH were more prominent in COPD patients with severe PH. Clinical symptoms assessed by CAT and Borg's scales, COPD exacerbation rate, the right atrium size, sysPAP, blood levels of C-reactive protein, fibrinogen, NT-proCNP and NT-proBNP predicted mortality of patients with COPD and PH. Survival of COPD patients with PH depended on PH severity. Conclusion. In most patients with COPD and PH, PH was moderate. PH aggravated severity of clinical signs and symptoms and increased the risk of mortality. In-hospital survival of patients with COPD and PH depended on PH severity.
About the Authors
Viliya V. Gaynitdinova
Bashkir Federal State Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Associate Professor at Department of Therapy and Clinical Pharmacology, Bashkir State Medical University; tel.: (347) 272-23-85;
Competing Interests: There is no conflict of interest. The study was performed without any sponsorship.
Russian Federation
Doctor of Medicine, Associate Professor at Department of Therapy and Clinical Pharmacology, Bashkir State Medical University; tel.: (347) 272-23-85;
Competing Interests: There is no conflict of interest. The study was performed without any sponsorship.
Sergey N. Avdeev
Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Russian Federation
Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Clinical Division, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; tel.: (495) 465-52-64;
Competing Interests: There is no conflict of interest. The study was performed without any sponsorship.
Russian Federation
Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Clinical Division, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; tel.: (495) 465-52-64;
Competing Interests: There is no conflict of interest. The study was performed without any sponsorship.
References
1. Global Initiative for Chronic Obstructive Lung Disease, 2016. Available at: http://goldcopd.org
2. Chuchalin A.G., Khaltaev N., Antonov N.S. et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int. J. COPD. 2014; 9: 963–974. DOI: 10.2147/COPD.S67283.
3. Weitzenblum E., Hirth C., Ducolone A. et al. Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease. Thorax. 1981; 36 (10): 752–758.
4. Sertogullarindan B., Gumrukcuoglu H.A., Sezgi C. et al. Frequency of pulmonary hypertension in patients with COPD due to biomass smoke and tobacco smoke. Int. J. Med. Sci. 2012; 9 (6): 406–412. DOI: 10.7150/ijms.4715.
5. Scharf S.M., Iqbal M., Keller C. et al. Hemodynamic characterization of patients with severe emphysema. Am. J. Respir. Crit. Care Med. 2002; 166 (3): 314–322. DOI: 10.1164/rccm.2107027.
6. Vizza C.D., Lynch J.P., Ochoa L.L. et al. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest. 1998; 113 (3): 576–583.
7. Chaouat A., Bugnet A.-S., Kadaoui N. et al. Severe pulmonary hypertension and chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2005; 172 (2): 189–194. DOI: 10.1164/rccm.200401-006OC.
8. Seeger W., Adir Y., Barberà J.A. et al. Pulmonary hypertension in chronic lung diseases. J. Am. Coll. Cardiol. 2013; 62 (25, Suppl.): D110–116. DOI: 10.1016/j.jacc.2013.10.036.
9. Galiè N., Humbert M., Vachiery J.-L. et al. 2015 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 (1): 67–119. DOI: 10.1093/eurheartj/ehv317.
10. Thabut G., Dauriat G., Stern J.B. et al. Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest. 2005; 127 (5): 1531–1536. DOI: 10.1378/chest.127.5.1531
11. Andersen K.H., Iversen M., Kjaergaard J. et al. Prevalence, predictors and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease. J. Heart Lung Transplant. 2012; 31: 373–380. DOI: 10.1016/j.healun.2011.11.020.
12. Avdeev S.N. Current approach to diagnosis and therapy of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Pul'monologiya. 2009; (1): 90–101 (in Russian).
13. Neklyudova G.V., Avdeev S.N., and Baymakanova G.E. Chronic obstructive pulmonary disease and pulmonary hypertension: brain natriuretic peptide as a marker of pulmonary hypertension. Pul'monologiya. 2013; (3): 31–35 (in Russian). DOI: 10.18093/0869-0189-2013-0-3-31-35.
14. Jyothula S., Safdar Z. Update on pulmonary hypertension complicating chronic obstructive pulmonary disease. Int. J. Chron. Obstruct. Pulmon. Dis. 2009; 4: 351–363. DOI: 10.2147/COPD.S5102.
15. Oswald-Mammosser M., Weitzenblum E., Quoix E. et al. Prognostic factors in COPD patients receiving long-termoxygen therapy. Importance of pulmonary artery pressure. Chest. 1995; 107 (5): 1193–1198.
16. Kessler R., Oswald-Mammosser M. Does lung volume reduction surgery compromise the pulmonary circulation? Am. J. Respir. Crit. Care Med. 1999; 160 (4): 1429–1430. DOI: 10.1164/ajrccm.160.4.16040_2.
17. Fessler H.E. Heart-lung interactions: applications in the critically ill. Eur. Respir. J. 1997; 10 (1): 226–237.
18. Sanders C., Nath P.H., Bailey W. Detection of empyzema with computed tomography: correlation with pulmonary function tests and chest radiography. Invest. Radiol. 1988; 23 (4): 262–266.
19. Barberà J.A., Peinado V.I., Santos S. Pulmonary hypertension in chronic obstructive pulmonary disease. Eur. Respir. J. 2003; 21 (5): 892–905.
20. Zharinov O.I., Saaid S., and Komorovskiy R.R. The right heart and interventricular interaction in patients with chronic heart failure. Kardiologiya. 2000; 11: 45–49 (in Russian).
21. Naeije R. Pulmonary hypertension and right heart failure in chronic obstructive pulmonary disease. Proc. Am. Thorac. Soc. 2005; 2 (1): 20–22. DOI: 10.1513/pats.200407-037MS.
22. Nekrasov A.A., Kuznetsov A.N., Mel'nichenko O.V., and Kabanova T.I. Heart remodeling in patients with chronic obstructive pulmonary disease and pulmonary hypertension treated with ACE inhibitors. Pul'monologiya. 2012; (2): 52–55 (in Russian). DOI: 10.18093/0869-0189-2012-0-2-52-55.
23. Kohama A., Tanouchi J., Masatsugu H. et. al. Pathologic involvement of the left ventricle in chronic cor pulmonale. Chest. 1990; 98 (4): 794–800.
24. Oswald-Mammosser M., Weitzenblum E., Quoix E. et al. Prognosticfactorsin COPD patient sreceiving long-termoxygen therapy. Importance of pulmonary artery pressure. Chest. 1995; 107 (5):1193–1198.
25. Kessler R., Faller M., Weitzenblum E. et al. “Natural history” of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease. Am. J. Respir. Crit. Care Med. 2001; 164 (2): 219–224. DOI: 10.1164/ajrccm.164.2.2006129.
26. Sims M.W., Margolis D.J., Localio A.R. et al .Impact of pulmonary artery pressure on exercise function in severe COPD. Chest. 2009; 136 (2):412–419. DOI: 10.1378/chest.08-2739.
27. Jyothula S., Safdar Z. Update on pulmonary hypertension complicating chronic obstructive pulmonary disease. Int. J. Chron. Obstruct. Pulmon. Dis. 2009; 4: 351–363.
28. Cavaillés A., Brinchault-Rabin G., Dixmier A., et al. Comorbidities of COPD. Eur. Respir. Rev. 2013; 22: 454–475. DOI: 10.1183/09059180.00008612.
29. Weitzenblum E., Sautegeau A., Ehrhart M. et al. Long-term course of pulmonary arterial pressure in chronic obstructive pulmonary disease. Am. Rev. Respir. Dis. 1984; 130 (6): 993–998. DOI: 10.1164/arrd.1984.130.6.993.
30. Burrows B., Kettel L.J., Niden A.H. et al. Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N. Engl. J. Med. 1972; 286 (17): 912–918.
31. Celli B.R., Cote C.G., Marin J.M. et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N. Engl. J. Med. 2004; 350 (10): 1005–1012. DOI: 10.1056/NEJMoa021322.
32. Cazzola M., MacNee W., Martinez F.J. et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur. Respir. J. 2008; 31 (2): 416–469. DOI: 10.1183/09031936.00099306.
33. Moreno A., Monton C., Belmonte Y. et al. Causes of death and risk factors for mortality in patients with severe chronic obstructive pulmonary disease. Arch. Bronconeumol. 2009; 45 (4): 181–186. DOI: 10.1016/j.arbres.2008.09.004.
34. Vestbo J., Prescott E., Almdal T. et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am. J. Respir. Crit. Care Med. 2006; 173 (1): 79–83. DOI: 10.1164/rccm.200506-969OC.
35. Schols A.M., Broekhuizen R., Weling-Scheepers C.A., Wouters E.F. Body composition and mortality in chronic obstructive pulmonary disease. Am. J. Clin. Nutr. 2005; 82 (1): 53–59.
36. Landbo C., Prescott E., Lange P. et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1999; 160 (6): 1856–1861. DOI: 10.1164/ajrccm.160.6.9902115.
37. Chailleux E., Laaban J.P., Veale D. Prognostic value of nutritional depletion in patients with COPD treated by long term oxygen therapy: data from the ANTADIR observatory. Chest. 2003; 123 (5): 1460–1466.
38. Soler-Cataluña J.J., Sánchez-Sánchez L., Martínez-García M.A. et al. Mid-arm muscle area is a better predictor of mortality than body mass index in COPD. Chest. 2005; 128 (4): 2108–2115. DOI: 10.1378/chest.128.4.2108.
39. Chazova I.E., Martynyuk T.V., Avdeev S.N., et al. Diagnosis and treatment of pulmonary hypertension. Clinical guidelines. Moscow; 2013 (in Russian). Available at: http://mzdrav.rk.gov.ru/file/mzdrav_18042014
Review
For citations:
Gaynitdinova V.V., Avdeev S.N. Chronic obstructive pulmonary disease and pulmonary hypertension: clinical course, survival and mortality predictors. PULMONOLOGIYA. 2017;27(3):357-365. (In Russ.) https://doi.org/10.18093/0869-0189-2017-27-3-357-365
Views:
2865
Email this article 