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Sassmann, T.
Early recognition of pulmonary vascular changes with exercise right heart catheterization in patients with COPD
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universitt Graz; 2023. pp. 86 [OPEN ACCESS]
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Authors Med Uni Graz:
Advisor:: Kovacs Gabor; Olschewski Horst; Zirlik Andreas
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Abstract:: Background and aims: Chronic obstructive pulmonary disease (COPD) is frequently complicated by pulmonary hypertension (PH), which is accompanied with exercise limitation and poor outcome. We hypothesized that even COPD patients without relevant resting PH are limited by pathological pulmonary hemodynamics during physical activity. Methods: We retrospectively analyzed consecutive COPD patients with resting mean pulmonary arterial pressure (mPAP) < 25 mmHg and compared them to age- and sex-matched controls without chronic pulmonary disease. All patients underwent clinical work-up including clinically indicated invasive hemodynamic assessment at rest and during exercise. Chi-square tests were performed for categorical variables and Fisher’s exact test or Mann-Whitney-U-tests for continuous data. With Spearman rank correlation tests, associations were analyzed. Results: 26 patients with COPD (female/male: 16/10, 66±11yr, FEV1: 56±25 %predicted) and 26 age- and sex-matched controls (FEV1: 96±22 %predicted) were analyzed. COPD patients presented with slightly increased mPAP (21 (18-23) vs. 17 (14-20) mmHg, p=0.022), pulmonary vascular resistance (PVR) (2.5 (1.9-3.0) vs. 1.9 (1.5-2.4) WU, p=0.020) at rest compared to controls. During exercise, COPD patients had higher mPAP (47 (40-52) vs. 38 (32-44) mmHg, p=0.015) and PVR (3.1 (2.2-3.7) vs. 1.7 (1.1-2.9) WU, p=0.028) and lower individual peak work load (50 (50-75) vs. 100 (75-125) Watt, p=0.002). Compared to controls, the mPAP/cardiac output slope was significantly increased in COPD patients (6.9 (5.5-10.9) vs. 3.7 (2.4-7.4) vs.) mmHg/L/min, p=0.007) and negatively correlated with both 6-minute walk test (r=-0.46, p=0.001) and peak oxygen uptake (r=-0.46, p=0.007). Conclusion: Even COPD patients presenting with mild elevation of pulmonary arterial pressure and resistance, show exercise pulmonary hemodynamics with a strongly increased mPAP/CO-slope, limiting their exercise capacity.