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Current Respiratory Medicine Reviews

Editor-in-Chief

ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Research Article

Risk Factors Associated with Development of Pulmonary Arterial Hypertension and Corpulmonale in Patients with Chronic Obstructive Pulmonary Disease

Author(s): Chaya Sindaghatta Krishnarao, Mahendra Maheshwarappa, Thippeswamy Thippeswamy, Jayaraj Biligere Siddaiah, Komarla Sundararaja Lokesh and Padukudru Anand Mahesh*

Volume 15, Issue 4, 2019

Page: [289 - 298] Pages: 10

DOI: 10.2174/1573398X15666191018151526

Abstract

Background: Chronic Obstructive Pulmonary Disease is an important cause of morbidity and mortality globally. The onset of pulmonary hypertension and corpulmonale is associated with decreased survival in patients with COPD.

Objective: To assess risk factors associated with the development of pulmonary hypertension and corpulmonale and to identify high-risk phenotypes who may need early evaluation and intervention.

Methods: Consecutive adult patients with COPD were evaluated for factors influencing the development of pulmonary hypertension and corpulmonale which included symptomatology, hospitalization in the previous year, MMRC dyspnea grade, SGRQ score, 6 minute walk test, ABG, CRP, spirometry and echocardiography.

Results: We found Pulmonary Hypertension in 36(30%) patients and 27(22.5%) had corpulmonale. On multivariate analysis, we found PaO2 ≤75 mm Hg and six minute walk test <80% predicted to be significantly associated with the development of Pulmonary hypertension and we found hospitalization in the previous year to be significantly and independently associated with the development of corpulmonale.

Conclusion: We observed hospitalization in the previous year was an independent risk factor for the development of corpulmonale and six-minute walk test <80% predicted, PaO2 <75 mm Hg were independent risk factors for the development of pulmonary hypertension.

Keywords: COPD, corpulmonale, mortality, pulmonary hypertension, cardiac complication, echocardiography.

Graphical Abstract

[1]
Global, regional, and national deaths, prevalence, disabilityadjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 - The Lancet Respiratory Medicine. Available at. https://www. thelancet.com/journals/lanres/article/PIIS2213-2600(17)30293-X/fulltext Accessed July 6, 2018
[2]
Nishimura K, Tsukino M. Clinical course and prognosis of patients with chronic obstructive pulmonary disease. Curr Opin Pulm Med 2000; 6(2): 127-32.
[http://dx.doi.org/10.1097/00063198-200003000-00008] [PMID: 10741772]
[3]
Weitzenblum E. Chronic cor pulmonale. Heart 2003; 89(2): 225-30.
[http://dx.doi.org/10.1136/heart.89.2.225] [PMID: 12527688]
[4]
Han MK, McLaughlin VV, Criner GJ, Martinez FJ. Pulmonary diseases and the heart. Circulation 2007; 116(25): 2992-3005.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.106.685206] [PMID: 18086941]
[5]
Traver GA, Cline MG, Burrows B. Predictors of mortality in chronic obstructive pulmonary disease. A 15-year follow-up study. Am Rev Respir Dis 1979; 119(6): 895-902.
[PMID: 453709]
[6]
Keller CA, Shepard JW Jr, Chun DS, Vasquez P, Dolan GF. Pulmonary hypertension in chronic obstructive pulmonary disease. Multivariate analysis. Chest 1986; 90(2): 185-92.
[http://dx.doi.org/10.1378/chest.90.2.185] [PMID: 3731890]
[7]
Oswald-Mammosser M, Apprill M, Bachez P, Ehrhart M, Weitzenblum E. Pulmonary hemodynamics in chronic obstructive pulmonary disease of the emphysematous type. Respiration 1991; 58(5-6): 304-10.
[http://dx.doi.org/10.1159/000195950] [PMID: 1792422]
[8]
Scharf SM, Iqbal M, Keller C, Criner G, Lee S, Fessler HE. National Emphysema Treatment Trial (NETT) Group. Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med 2002; 166(3): 314-22.
[http://dx.doi.org/10.1164/rccm.2107027] [PMID: 12153963]
[9]
Burrows B, Kettel LJ, Niden AH, Rabinowitz M, Diener CF. Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med 1972; 286(17): 912-8.
[http://dx.doi.org/10.1056/NEJM197204272861703] [PMID: 5013974]
[10]
Thabut G, Dauriat G, Stern JB, et al. Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest 2005; 127(5): 1531-6.
[http://dx.doi.org/10.1378/chest.127.5.1531] [PMID: 15888824]
[11]
Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J 2008; 32(5): 1371-85.
[http://dx.doi.org/10.1183/09031936.00015608] [PMID: 18978137]
[12]
MacNee W. Pulmonary circulation, cardiac function and fluid balance Chronic Obstructive Pulmonary Disease. Boston, MA: Springer 1995; pp. 243-91.
[http://dx.doi.org/10.1007/978-1-4899-4525-9_11]
[13]
Celli BR, MacNee W. ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23(6): 932-46.
[http://dx.doi.org/10.1183/09031936.04.00014304] [PMID: 15219010]
[14]
Weitzenblum E, Chaouat A. Cor pulmonale. Chron Respir Dis 2009; 6(3): 177-85.
[http://dx.doi.org/10.1177/1479972309104664] [PMID: 19643833]
[15]
Miller MR, Hankinson J, Brusasco V, et al. ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J 2005; 26(2): 319-38.
[http://dx.doi.org/10.1183/09031936.05.00034805] [PMID: 16055882]
[16]
Pulmonale WEC on CC, Organization WH. Chronic corpulmonale : report of an Expert Committee [meeting held in Geneva from 10 to 15 October 1960]. 1961.Available at. http://www.who.int/iris/handle/10665/40483 Accessed October 6, 2017
[17]
Taichman DB, Mandel J, Smith KA, Yuan JX-J. Pulmonary Arterial HypertensionFishman’s Pulmonary Diseases and Disorders5thed. NewYork, NY: McGraw-HillEducation 2015.accessmedicine.mhmedical.com/content.aspx?aid=1122362559
[18]
Simonneau G, Robbins IM, Beghetti M, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2009; 54(1)(Suppl.): S43-54.
[http://dx.doi.org/10.1016/j.jacc.2009.04.012] [PMID: 19555858]
[19]
Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001; 163(5): 1256-76.
[http://dx.doi.org/10.1164/ajrccm.163.5.2101039] [PMID: 11316667]
[20]
Budev MM, Arroliga AC, Wiedemann HP, Matthay RA. Cor pulmonale: an overview. Semin Respir Crit Care Med 2003; 24(3): 233-44.
[http://dx.doi.org/10.1055/s-2003-41105] [PMID: 16088545]
[21]
Shujaat A, Minkin R, Eden E. Pulmonary hypertension and chronic cor pulmonale in COPD. Int J Chron Obstruct Pulmon Dis 2007; 2(3): 273-82.
[PMID: 18229565]
[22]
Bardsley P, Evely R, Howard P. Hypoxic cor pulmonale: A review. Herz 1986; 11(3): 155-68.
[PMID: 2943654]
[23]
Gupta NK, Agrawal RK, Srivastav AB, Ved ML. Echocardiographic evaluation of heart in chronic obstructive pulmonary disease patient and its co-relation with the severity of disease. Lung India 2011; 28(2): 105-9.
[http://dx.doi.org/10.4103/0970-2113.80321] [PMID: 21712919]
[24]
Kinagi1 S, Patil2 S, Afiya. Analysis of chronic obstructive pulmonary disease with clinical parameters, ecg and echo. 2014; (5749): Available at. https://jemds.com/latest-articles.php?at_id=5749 Accessed August 9, 2017
[25]
Weitzenblum E, Hirth C, Ducolone A, Mirhom R, Rasaholinjanahary J, Ehrhart M. Prognostic value of pulmonary artery pressure in chronic obstructive pulmonary disease. Thorax 1981; 36(10): 752-8.
[http://dx.doi.org/10.1136/thx.36.10.752] [PMID: 7330793]
[26]
Peinado VI, Barberá JA, Abate P, et al. Inflammatory reaction in pulmonary muscular arteries of patients with mild chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159(5 Pt 1): 1605-11.
[http://dx.doi.org/10.1164/ajrccm.159.5.9807059] [PMID: 10228134]
[27]
Dinh-Xuan AT, Higenbottam TW, Clelland CA, et al. Impairment of endothelium-dependent pulmonary-artery relaxation in chronic obstructive lung disease. N Engl J Med 1991; 324(22): 1539-47.
[http://dx.doi.org/10.1056/NEJM199105303242203] [PMID: 2027358]
[28]
Santos S, Peinado VI, Ramirez J, et al. Enhanced expression of vascular endothelial growth factor in pulmonary arteries of smokers and patients with moderate chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2003; 167(9): 1250-6.
[http://dx.doi.org/10.1164/rccm.200210-1233OC] [PMID: 12615615]
[29]
Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease. A prospective study of 200 patients. N Engl J Med 1969; 280(8): 397-404.
[http://dx.doi.org/10.1056/NEJM196902202800801] [PMID: 5763088]
[30]
Weitzenblum E, Sautegeau A, Ehrhart M, Mammosser M, Hirth C, Roegel E. Long-term course of pulmonary arterial pressure in chronic obstructive pulmonary disease. Am Rev Respir Dis 1984; 130(6): 993-8.
[PMID: 6439091]
[31]
Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159(1): 158-64.
[http://dx.doi.org/10.1164/ajrccm.159.1.9803117] [PMID: 9872834]
[32]
Barberà JA, Peinado VI, Santos S. Pulmonary hypertension in chronic obstructive pulmonary disease. Eur Respir J 2003; 21(5): 892-905.
[http://dx.doi.org/10.1183/09031936.03.00115402] [PMID: 12765440]
[33]
Hunter C, Barer GR, Shaw JW, Clegg EJ. Growth of the heart and lungs in hypoxic rodents: a model of human hypoxic disease. Clin Sci Mol Med 1974; 46(3): 375-91.
[http://dx.doi.org/10.1042/cs0460375] [PMID: 4818217]
[34]
Wilkinson M, Langhorne CA, Heath D, Barer GR, Howard P. A pathophysiological study of 10 cases of hypoxic cor pulmonale. Q J Med 1988; 66(249): 65-85.
[PMID: 3174923]
[35]
Morrell NW, Morris KG, Stenmark KR. Role of angiotensin-converting enzyme and angiotensin II in development of hypoxic pulmonary hypertension. Am J Physiol 1995; 269(4 Pt 2): H1186-94.
[PMID: 7485548]
[36]
Chen SJ, Chen YF, Meng QC, Durand J, Dicarlo VS, Oparil S. Endothelin-receptor antagonist bosentan prevents and reverses hypoxic pulmonary hypertension in rats. J Appl Physiol 1995; 79(6): 2122-31.
[http://dx.doi.org/10.1152/jappl.1995.79.6.2122] [PMID: 8847282]
[37]
DiCarlo VS, Chen SJ, Meng QC, et al. ETA-receptor antagonist prevents and reverses chronic hypoxia-induced pulmonary hypertension in rat. Am J Physiol 1995; 269(5 Pt 1): L690-7.
[PMID: 7491990]
[38]
Mechtcheriakova D, Wlachos A, Holzmüller H, Binder BR, Hofer E. Vascular endothelial cell growth factor-induced tissue factor expression in endothelial cells is mediated by EGR-1. Blood 1999; 93(11): 3811-23.
[PMID: 10339488]
[39]
Kent BD, Mitchell PD, McNicholas WT. Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis 2011; 6: 199-208.
[PMID: 21660297]
[40]
Fisher MR, Forfia PR, Chamera E, et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179(7): 615-21.
[http://dx.doi.org/10.1164/rccm.200811-1691OC] [PMID: 19164700]

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