Relevance of Cor Pulmonale in COPD With and Without Pulmonary Hypertension: A Retrospective Cohort Study

Frontiers in Cardiovascular Medicine

Stanislav Keranov¹  Friedrich Grimminger²  Stefan Kuhnert³  Marlene Faber³  Ekaterina Krauss³  Athiththan Yogeswaran³  Henning Gall³  Manuel J. Richter³  Hossein Ardeschir Ghofrani³  Khodr Tello³  Zvonimir A. Rako³  Werner Seeger³  Robert Naeije⁴ 

[1] Department of Cardiology and Angiology, DZHK (German Center for Cardiovascular Research), University of Giessen, Giessen, Germany;Department of Internal Medicine, Member of the German Center for Lung Research, Institute for Lung Health, Cardio-Pulmonary Institute, Universities of Giessen and Marburg Lung Center, Giessen, Germany;Department of Internal Medicine, Member of the German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Justus-Liebig-University Giessen, Giessen, Germany;Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium;

关键词: chronic obstructive pulmonary disease;    cor pulmonale;    pulmonary arterial hypertension;    right ventricle;    risk stratification;   

DOI  :  10.3389/fcvm.2022.826369

来源: DOAJ

【 摘 要 】

BackgroundThe relevance of cor pulmonale in COPD and pulmonary hypertension due to COPD (PH-COPD) is incompletely understood. We aimed to investigate the relationship of right ventricular-pulmonary arterial (RV-PA) uncoupling with disease severity in COPD, and the relationship of RV-PA uncoupling and use of targeted PH therapies with mortality in PH-COPD.MethodsWe retrospectively analyzed 231 patients with COPD without PH and 274 patients with PH-COPD. COPD was classified according to GOLD stages and the modified Medical Research Council dyspnoea scale. PH was categorized as mild-to-moderate or severe. RV-PA uncoupling was assessed as the echocardiographic tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio.ResultsOf the cohort with COPD without PH, 21, 58, 54 and 92 were classified as GOLD I, II, III and IV, respectively. Patients in advanced GOLD stages and those with severe dyspnoea showed significantly decreased TAPSE/PASP.Of the PH-COPD cohort, 144 had mild-to-moderate PH and 130 had severe PH. During follow-up, 126 patients died. In univariate Cox regression, TAPSE/PASP and 6-min walk distance (6MWD; 10 m increments) predicted survival [hazard ratios (95% CI): 0.12 (0.03–0.57) and 0.95 (0.93–0.97), respectively]; notably, PH severity and simplified European Society of Cardiology/European Respiratory Society risk stratification did not. Among patients in the lowest or intermediate tertiles of TAPSE/PASP and 6MWD, those with targeted PH therapy had higher survival than those without (53 vs. 17% at 3 years).ConclusionCor pulmonale (decreased TAPSE/PASP and 6MWD) is associated with disease severity in COPD and predicts outcome in PH-COPD.

【 授权许可】

Unknown