Chest. 2022 Jan 26:S0012-3692(22)00192-1. doi: 10.1016/j.chest.2022.01.031. Online ahead of print.
ABSTRACT
BACKGROUND: Severe pulmonary hypertension (PH) is prognostically highly relevant in patients with COPD. The criteria for severe PH have been defined based on hemodynamic thresholds in right heart catheterization.
RESEARCH QUESTION: Can non-invasive clinical tools predict severe PH in COPD patients? How does the mortality risk change with increasing severity of airflow-limitation and pulmonary vascular disease?
STUDY DESIGN AND METHODS: We retrospectively analyzed all consecutive COPD patients with suspected PH undergoing in-depth clinical evaluation including right heart catheterization in our PH clinic between 2005 and 2018. Clinical variables potentially indicative of severe PH or death were analyzed using uni- and stepwise multivariable logistic regression and Cox regression analysis adjusted for age and sex.
RESULTS: We included 142 patients (FEV1: median: 55.0 IQR: 42.4-69.4%, mean pulmonary arterial pressure (mPAP): 35 mmHg (IQR: 27-43). A multivariable model combining echocardiographic systolic PAP ≥ 56 mmHg, N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels ≥ 650 pg/ml and main pulmonary artery / ascending aorta diameter ratio (PA/Ao-ratio) in chest CT ≥ 0.93 predicted severe PH with high positive and negative predictive values (both 94%). After correction for age and gender, both airflow-limitation (p=0.002; GOLD 1-2 vs. 3: HR 1.56 [95%CI: 0.90 – 2.71]; GOLD 1-2 vs. 4: HR 3.45 [95%CI: 1.75 – 6.79]) and PH severity (p=0.012; HR: 1.85 [95%CI: 1.15 – 2.99]) remained independently associated with survival. The combination of GOLD 3-4 airflow-limitation and severe PH had the poorest survival (HR for death 3.26 [95% CI: 1.62-6.57], p=0.001 vs. GOLD 1-2 combined with non-severe PH).
INTERPRETATION: In COPD patients, the combination of echocardiography, NT-proBNP and PA/Ao-ratio predicts severe PH with high sensitivity and specificity. The contribution of severe PH and severe airflow-limitation to impaired survival is comparable.
PMID:35092746 | DOI:10.1016/j.chest.2022.01.031
