Categorization and impact of pulmonary hypertension in patients with advanced COPD

Michael J. Cuttica, Ravi Kalhan, Oksana A. Shlobin, Shahzad Ahmad, Mark Gladwin, Roberto Machado, Scott D. Barnett, Steven D. Nathan

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Introduction: The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant. Methods: A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed. Results: 4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4%, with pulmonary venous hypertension (PVH) accounting for an additional 17.2% of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = -1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = -1.91; p < 0.001). Both PH (HR 1.23 95%CI [1.01-1.50]) and PVH (HR 1.35 95%CI [1.11-1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95%CI [1.04-1.55], PVH: HR 1.40; 95%CI [1.13-1.73]). Conclusion: PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.

Original languageEnglish (US)
Pages (from-to)1877-1882
Number of pages6
JournalRespiratory Medicine
Volume104
Issue number12
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

Fingerprint

Pulmonary Hypertension
Chronic Obstructive Pulmonary Disease
Hemodynamics
Cardiac Catheterization
Lung
Transplants
Tissue and Organ Procurement
Waiting Lists
Mortality
Respiratory Function Tests
Vital Capacity
Pulmonary Artery
Demography
Databases
Phenotype
Pressure

Keywords

  • Chronic obstructive pulmonary disease
  • Functional status
  • Prevalence
  • Pulmonary hypertension
  • Six minute walk test

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Cuttica, M. J., Kalhan, R., Shlobin, O. A., Ahmad, S., Gladwin, M., Machado, R., ... Nathan, S. D. (2010). Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respiratory Medicine, 104(12), 1877-1882. https://doi.org/10.1016/j.rmed.2010.05.009

Categorization and impact of pulmonary hypertension in patients with advanced COPD. / Cuttica, Michael J.; Kalhan, Ravi; Shlobin, Oksana A.; Ahmad, Shahzad; Gladwin, Mark; Machado, Roberto; Barnett, Scott D.; Nathan, Steven D.

In: Respiratory Medicine, Vol. 104, No. 12, 01.12.2010, p. 1877-1882.

Research output: Contribution to journalArticle

Cuttica, MJ, Kalhan, R, Shlobin, OA, Ahmad, S, Gladwin, M, Machado, R, Barnett, SD & Nathan, SD 2010, 'Categorization and impact of pulmonary hypertension in patients with advanced COPD', Respiratory Medicine, vol. 104, no. 12, pp. 1877-1882. https://doi.org/10.1016/j.rmed.2010.05.009
Cuttica, Michael J. ; Kalhan, Ravi ; Shlobin, Oksana A. ; Ahmad, Shahzad ; Gladwin, Mark ; Machado, Roberto ; Barnett, Scott D. ; Nathan, Steven D. / Categorization and impact of pulmonary hypertension in patients with advanced COPD. In: Respiratory Medicine. 2010 ; Vol. 104, No. 12. pp. 1877-1882.
@article{497737ccb6b34f1b92bf213529fd0d76,
title = "Categorization and impact of pulmonary hypertension in patients with advanced COPD",
abstract = "Introduction: The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant. Methods: A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed. Results: 4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4{\%}, with pulmonary venous hypertension (PVH) accounting for an additional 17.2{\%} of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = -1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = -1.91; p < 0.001). Both PH (HR 1.23 95{\%}CI [1.01-1.50]) and PVH (HR 1.35 95{\%}CI [1.11-1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95{\%}CI [1.04-1.55], PVH: HR 1.40; 95{\%}CI [1.13-1.73]). Conclusion: PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.",
keywords = "Chronic obstructive pulmonary disease, Functional status, Prevalence, Pulmonary hypertension, Six minute walk test",
author = "Cuttica, {Michael J.} and Ravi Kalhan and Shlobin, {Oksana A.} and Shahzad Ahmad and Mark Gladwin and Roberto Machado and Barnett, {Scott D.} and Nathan, {Steven D.}",
year = "2010",
month = "12",
day = "1",
doi = "10.1016/j.rmed.2010.05.009",
language = "English (US)",
volume = "104",
pages = "1877--1882",
journal = "Respiratory Medicine",
issn = "0954-6111",
publisher = "W.B. Saunders Ltd",
number = "12",

}

TY - JOUR

T1 - Categorization and impact of pulmonary hypertension in patients with advanced COPD

AU - Cuttica, Michael J.

AU - Kalhan, Ravi

AU - Shlobin, Oksana A.

AU - Ahmad, Shahzad

AU - Gladwin, Mark

AU - Machado, Roberto

AU - Barnett, Scott D.

AU - Nathan, Steven D.

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Introduction: The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant. Methods: A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed. Results: 4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4%, with pulmonary venous hypertension (PVH) accounting for an additional 17.2% of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = -1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = -1.91; p < 0.001). Both PH (HR 1.23 95%CI [1.01-1.50]) and PVH (HR 1.35 95%CI [1.11-1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95%CI [1.04-1.55], PVH: HR 1.40; 95%CI [1.13-1.73]). Conclusion: PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.

AB - Introduction: The functional significance of pulmonary hypertension (PH) in COPD is unclear. The purpose of the study was to define the prevalence, severity and associated functional impact of PH in patients with severe COPD listed for lung transplant. Methods: A retrospective review of the Organ Procurement and Tissue Network (OPTN) database between 1997 and 2006 for patients with the primary diagnosis of COPD. Baseline demographics, hemodynamics, pulmonary function tests, six minute walk distance test (6MWD) and pre-transplant survival data was analyzed. Results: 4930 patients with COPD had evaluable right heart catheterization data (RHC). PH was present in 30.4%, with pulmonary venous hypertension (PVH) accounting for an additional 17.2% of patients. Patients with pulmonary hypertension walked an average of 28 m less than those with normal hemodynamics. Normal hemodynamics group: 261 ± 104 m, PH; 238 ± 106 m (p < 0.01), PVH: 228 ± 104 m (p < 0.05). In a multivariable analysis, the mean pulmonary artery pressure (β = -1.33; p = 0.01) was an independent predictor of a reduced 6MWD, as were forced vital capacity (β = 1.48; p < 0.001) and patient age (β = -1.91; p < 0.001). Both PH (HR 1.23 95%CI [1.01-1.50]) and PVH (HR 1.35 95%CI [1.11-1.65]) were shown to be independent risk factors for mortality on the waiting list, even after adjustment for age sex, race, BMI, lung function, severity of illness and diabetes (PH: HR 1.27; 95%CI [1.04-1.55], PVH: HR 1.40; 95%CI [1.13-1.73]). Conclusion: PH is common in advanced COPD and is associated with functional impairment and an increased mortality risk. Stratification by RHC determined pulmonary hemodynamics appears important in distinguishing distinct clinical phenotypes.

KW - Chronic obstructive pulmonary disease

KW - Functional status

KW - Prevalence

KW - Pulmonary hypertension

KW - Six minute walk test

UR - http://www.scopus.com/inward/record.url?scp=78650012669&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650012669&partnerID=8YFLogxK

U2 - 10.1016/j.rmed.2010.05.009

DO - 10.1016/j.rmed.2010.05.009

M3 - Article

C2 - 20547449

AN - SCOPUS:78650012669

VL - 104

SP - 1877

EP - 1882

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

IS - 12

ER -