Severe pulmonary hypertension associated with chronic obstructive pulmonary disease: A prospective French multicenter cohort

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:40

Article

Dauriat, Gaelle¹  Reynaud-Gaubert, Martine²  Cottin, Vincent³  Lamia, Bouchra^4,5  Montani, David⁶  Canuet, Mathieu⁷  Boissin, Clement⁸  Tromeur, Cecile⁹  Chaouat, Ari¹⁰  Degano, Bruno¹¹  Bergot, Emmanuel¹²  Sanchez, Olivier¹³  Prevot, Gregoire¹⁴  Sitbon, Olivier⁶  Thabut, Gabriel¹  Belhadi, Drifa¹⁵  de Beauregard, Yolande Costa¹⁶  Bencherif, Amina¹⁶  Humbert, Marc^6,17  Simonneau, Gerald^6,17  Laouenan, Cedric¹⁵  Mal, Herve¹ 

[1] Univ Paris 07, Serv Pneumol B, Hop Bichat, Inserm UMR1152, Paris, France

[2] Hop Nord Marseille, Serv Pneumol, Marseille, France

[3] Hop Louis Pradel, Serv Pneumol, Lyon, France

[4] Normandie Univ, Serv Pneumol, UNIROUEN, CHU Rouen,EA 3830, St Etienne Du Rouvray, France

[5] Grp Hosp Havre, St Etienne Du Rouvray, France

[6] Hop Bicetre, Serv Pneumol, Le Kremlin Bicetre, France

[7] Nouvel Hop Civil, Serv Pneumol, Strasbourg, France

[8] Hop Arnaud Villeneuve, Serv Pneumol, Montpellier, France

[9] Hop Cavale Blanche, Serv Pneumol, Brest, France

[10] Hop Brabois, Serv Pneumol, Nancy, France

[11] Hop Albert Michalon, Serv Pneumol, Grenoble, France

[12] Hop Cote Nacre, Serv Pneumol, Caen, France

[13] Hop Europeen Georges Pompidou, Serv Pneumol, Paris, France

[14] Hop Larrey, Serv Pneumol, Toulouse, France

[15] Hop Bichat Claude Bernard, Unite Rech Clin, Paris, France

[16] Hop Bichat Claude Bernard, Ctr Invest Clin, Paris, France

[17] Hop Bicetre, Pulm Hypertens Natl Referral Ctr, Le Kremlin Bicetre, France

关键词: chronic obstructive pulmonary disease;    pulmonary hypertension;    lung transplantation;   

DOI  :  10.1016/j.healun.2021.04.021

来源: Elsevier

【 摘 要 】

BACKGROUND: A small proportion of patients with chronic obstructive pulmonary disease (COPD) patients present severe pulmonary hypertension (PH), defined by mean pulmonary artery pressure (mPAP) >= 35 mm Hg measured by right heart catheterization. Little is known about the characteristics of severe PH-COPD. The aim of the study based on a national registry was to describe this phenotype. METHODS: We prospectively included and followed patients with incident PH-COPD. Clinical, functional, hemodynamic data at inclusion and follow-up were retrieved. Survival assessed by Kaplan Meier analysis was the primary end-point. RESULTS: From 2012 to 2016, 99 patients from 13 French centers were included in the study (82 males; median age 66.0 years [interquartile range 62.0-72.0]). At inclusion, most patients had marked dyspnea(55.6% and 22.2% New York Heart Association class III and IV, respectively). During 12 months before inclusion, 42.9% had an exacerbation requiring a hospitalization. Pulmonary function tests showed a moderate obstructive pattern with median (interquartile range) FEV1 50.0 [35.0-63.0] % predicted and low diffusing capacity for carbon monoxide, median 20.0 [16.5-30.6] % predicted. The median values for PaO2 and PaCO2 on room air were 50.0 [44.8-62.0] and 36.0 [31.1-43.0] mm Hg. Median values of mPAP, pulmonary artery occlusion pressure, cardiac index and pulmonary vascular resistance were 42.0 [37.0-48.0] mm Hg, 11.0 [9.0-14.0] mm Hg, 3.0 [2.4-3.6] L/min/m(2), and 6.3 [4.27.9] WU, respectively. Mean restricted survival was 15.0 [13.9-16.0] months. CONCLUSIONS: Severe PH-COPD is characterized by moderate airway obstruction but marked dyspnea and marked hypoxemia, low DLCO and high mPAP. This phenotype is associated with poor prognosis. (C) 2021 The Author(s). Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.

【 授权许可】

Free