Journal
CHEST
Volume 136, Issue 2, Pages 412-419Publisher
ELSEVIER
DOI: 10.1378/chest.08-2739
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Funding
- NHLBI NIH HHS [R01 HL082895-01, T32 HL007891-09, T32 HL007891-06, R01 HL082895, T32 HL007891-01, R01 HL086719-04, T32 HL007891-07, R01 HL082895-04, T32-HL-007891, T32 HL007891-10, T32 HL007891-03, K30 HL004134-06, R01 HL086719, K30 HL004134-02, K30 HL004134-01, T32 HL007891-12, R01 HL086719-01, R01 HL082895-04S1, R01 HL086719-02, R01 HL086719-03, T32 HL007891-11, T32 HL007891-02, HL086719, K30 HL004134, T32 HL007891-04, R01 HL082895-02, K30 HL004134-05, K30 HL004134-03, T32 HL007891, T32 HL007891-05, R01 HL082895-03, K30-HL-04134, K30 HL004134-04, T32 HL007891-08, HL082895] Funding Source: Medline
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Background: Although pulmonary hypertension commonly complicates COPD, the functional consequences of increased pulmonary artery pressures in patients with this condition remain poorly defined. Methods: We conducted a cross-sectional analysis of a cohort of 362 patients with severe COPD who were evaluated for lung transplantation. Patients with pulmonary hemodynamics measured by cardiac catheterization and available 6-min walk test results were included. The association of mean pulmonary artery pressure (mPAP) with pulmonary function, echocardiographic variables, and 6-min walk distance was assessed. Results: The prevalence of pulmonary hypertension (mPAP, > 25 mm Hg; pulmonary artery occlusion pressure [PAOP], < 16 mm Hg) was 23% (95% confidence interval, 19 to 27%). In bivariate analysis, higher mPAP was associated with lower FVC and FEV1, higher PCO2 and lower PO2 in arterial blood, and more right heart dysfunction. Multivariate analysis demonstrated that higher mPAP was associated with shorter distance walked in 6 min, even after adjustment for age, gender, race, height, weight, FEV1, and PAOP (-11 m for every 5 mm Hg rise in mPAP; 95% confidence interval, -21 to -0.7; p = 0.04). Conclusions: Higher pulmonary artery pressures are associated with reduced exercise function in patients with severe COPD, even after controlling for demographics, anthropomorphics, severity of airflow obstruction, and PAOP. Whether treatments aimed at lowering pulmonary artery pressures may improve clinical outcomes in COPD, however, remains unknown. (CHEST 2009; 136:412-419)
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