Detection of right sided heart changes and pulmonary hypertension in COPD patients

Abstract

Rationale: Assessing the function of the right side of the heart along with diagnosing of pulmonary hypertension and studying the hemodynamic abnormalities, thus studying functional limitations of pulmonary hypertension on COPD patients. Methods: Data from 51 COPD male patients between December 2012 and April 2013 were reviewed. PFTs (post bronchodilators FEV1 ⩽ 0.7), echo, BODE index were obtained, RHC was done only for 17 patients after their echo revealed PASP ⩾ 45 mmHg. Results: We found 11 patients (21.5%) had MPAP ⩾ 25 mmHg by RHC (35.27 ± 7.837) and 2 patients (∼4%) had severe PH (MPAP ⩾ 40 mmHg). The mean age 62 (±9.16) with smoking index 34 (±6.5). 63% of the patients had PASP ⩾ 35 mmHg by echocardiography while 24 patients (47%) had PASP ⩾ 45 mmHg. COPD patients with PH were more hypoxemic (53.73 ± 6.214 vs. 62.51 ± 10.999, p-value 0.00013), showed increased BODE index (8.45 ± 1.572 vs. 6.31 ± 2.604, p-value 0.0015), showed statistically significant difference in both BRV and LRV (3.725 ± 0.8625 vs. 4.500 ± 0.9849 p-value 0.0304 and 6.067 ± 0.9923 vs. 6.927 ± 0.7888, 0.006 respectively), showed a significant difference in the measurement of TAPSE (2.055 ± 0.5298, 3.142 ± 0.3437 with p-value 10 mmHg difference between PASP calculated by echo and measured by RHC. Conclusion: We conclude that PH in COPD patients is a common co-morbidity along with right sided changes. Echo could be used with caution during assessment of PASP as it was inaccurate. COPDPH patients had worse prognosis than COPD patients without PH. Clinical impact: Screening for PH in any COPD is highly recommended as it affects the prognosis. Echo could be used with caution during assessment of PASP in these patients.

Keywords

• Chronic obstructive pulmonary disease
• Hypoxemia
• Pulmonary hypertension
• Echocardiography
• Pulmonary catheterization
• Respiratory function tests