Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation.

Abstract

STUDY OBJECTIVES:

To assess the pulmonary hemodynamic characteristics in COPD candidates for lung volume reduction surgery (LVRS) or lung transplantation (LT).

DESIGN:

Retrospective study.

SETTING:

One center in France.

PATIENTS:

Two hundred fifteen patients with severe COPD who underwent right-heart catheterization before LVRS or LT.

RESULTS:

Mean age was 54.6 years. Pulmonary function test results were as follows: FEV(1), 24.3% predicted; total lung capacity, 128.3% predicted; residual volume, 259.7% predicted. Mean pulmonary artery pressure (PAPm) was 26.9 mm Hg. Pulmonary hypertension (PAPm > 25 mm Hg) was present in 50.2% and was moderate (PAPm, 35 to 45 mm Hg) or severe (PAPm > 45 mm Hg) in 9.8% and in 3.7% of patients, respectively. Cardiac index was low normal. PAPm was related to Pao(2) and alveolar-arterial oxygen gradient in multivariate analysis. Cluster analysis identified a subgroup of atypical patients (n = 16, 7.4%) characterized by moderate impairment of the pulmonary mechanics (mean FEV(1), 48.5%) contrasting with high level of pulmonary artery pressure (PAPm, 39.8 mm Hg), and severe hypoxemia (mean Pao(2), 46.2 mm Hg).

CONCLUSION:

While pulmonary hypertension is observed in half of the COPD patients with advanced disease, moderate-to-severe pulmonary hypertension is not a rare event in these patients. We individualized a subgroup of patients presenting with a predominant vascular disease that could potentially benefit from vasodilators.

• Authors: Gabriel Thabut, Gaëlle Dauriat, Jean Baptiste Stern, Damien Logeart, Antoine Lévy, Rolana Marrash-Chahla, Hervé Mal
• Journal: Chest (Chest) Vol. 127 Issue 5 Pg. 1531-6 (May 2005) ISSN: 0012-3692 [Print] United States
• PMID: 15888824 (Publication Type: Journal Article)

Topics

• Adult
• Cluster Analysis
• Female
• Hemodynamics
• Humans
• Hypertension, Pulmonary (epidemiology, physiopathology)
• Lung (physiopathology)
• Lung Transplantation
• Male
• Middle Aged
• Multivariate Analysis
• Pneumonectomy
• Pulmonary Disease, Chronic Obstructive (epidemiology, physiopathology, surgery)
• Respiratory Function Tests
• Retrospective Studies