Researchers at the Cairo University in Egypt recently reported that patients with chronic obstructive pulmonary disease (COPD) can also develop co-morbidities as pulmonary hypertension and cardiac alterations. The study was published in the Egyptian Journal of Chest Diseases and Tuberculosis and is entitled “Detection of right sided heart changes and pulmonary hypertension in COPD patients.”
COPD is a common progressive disease in which individuals develop serious breathing problems such as obstruction of the airways, shortness of breath (dyspnea) and acute exacerbations. It is one of the most common lung diseases and a major cause of morbidity and mortality worldwide. In the United States, COPD is the third leading cause of death. Exacerbations and co-morbidities contribute to COPD severity.
One common complication in COPD patients is pulmonary hypertension, which corresponds to an increased pressure in the blood vessels that supply the lungs; pulmonary hypertension is a life-threatening condition that can lead to difficulties in breathing and right-sided heart failure. COPD-associated pulmonary hypertension is considered a poor prognostic indicator, linked to worse oxygenation and higher mortality. Right heart catheterization (RHC) is a crucial diagnostic tool.
In this study, the function of the right-side of the heart along with the diagnosis of pulmonary hypertension and hemodynamic abnormalities were analyzed in order to assess functional limitations associated to pulmonary hypertension on COPD patients. Information was collected between December 2012 and April 2013 from 51 COPD male patients. Data on echocardiogram exam, PFT tests (post bronchodilators FEV1 ⩽ 0.7), and BODE index (to assess the body mass index) was recorded; only 17 patients underwent RHC because their echo showed pulmonary artery systolic pressure ⩾ 45 mmHg.
Researchers found that 11 out of the 51 patients had a mean pulmonary artery pressure ⩾ 25 mmHg indicating pulmonary hypertension and 2 patients had severe pulmonary hypertension, with a mean pulmonary artery pressure ⩾ 40 mmHg. Cardiovascular disease is known to be a common comorbidity in COPD patients and in this study, 45% of the COPD patients with pulmonary hypertension showed evidence of ischemic heart disease and 18% had arrhythmias. In terms of right-side dimensions, the team found that 11 patients with pulmonary hypertension had a right ventricular enlargement in comparison with patients without pulmonary hypertension. COPD patients with pulmonary hypertension were also found to be more hypoxemic (reduced oxygen content), have more severe airway obstruction and greater BODE index in comparison with COPD patients without pulmonary hypertension. Concerning diagnosis, the research team believes that an echocardiogram can be helpful, but the results have to be interpreted cautiously and the ones who are positive should be confirmed by RHC.
The authors concluded that pulmonary hypertension and right side changes are common complications in COPD patients that affect survival and limit exercise capacity. Of importance, COPD patients with pulmonary hypertension are more prone to co-morbidities than patients with COPD alone. The research team suggests that pulmonary hypertension screening in COPD patients is essential as it can affect the prognosis – COPD patients with pulmonary hypertension have a worse prognosis in comparison with COPD patients without pulmonary hypertension.