Characteristics of Chronic Obstructive Pulmonary Disease Patients with Pulmonary Hypertension Assessed by Echocardiography in a Three-Year Observational Cohort Study
Received 13 September 2019
Accepted for publication 14 February 2020
Published 3 March 2020 Volume 2020:15 Pages 487—499
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Shingo Nakayama,1 Shotaro Chubachi,1 Kaori Sakurai,1 Hidehiro Irie,1 Akihiro Tsutsumi,1 Mizuha Hashiguchi,2 Yuji Itabashi,3 Mitsushige Murata,4 Hidetoshi Nakamura,5 Koichiro Asano,6 Koichi Fukunaga1
1Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; 2Division of Pulmonary Medicine, Keiyu Hospital, Yokohama, Kanagawa 220-0012, Japan; 3Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan; 4Center for Preventive Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; 5Division of Pulmonary Medicine, Saitama Medical University Hospital, Saitama 350-0495, Japan; 6Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara-Shi, Kanagawa 259-1193, Japan
Correspondence: Shotaro Chubachi
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo 160-8582, Japan
Background: Pulmonary hypertension (PH) is a major comorbidity of chronic obstructive pulmonary disease (COPD). However, the association of PH detected by echocardiography and COPD-related outcome in longitudinal follow-up has not been elucidated. In this study, we aimed to investigate the relationship between clinical characteristics of COPD patients with PH detected by echocardiography and various outcome parameters such as COPD exacerbation and health status over a three-year observation period.
Methods: In this observational study, we analyzed patients with COPD who underwent chest computed tomography and echocardiography at baseline (n = 183).
Results: The prevalence of PH was 21.9% (40 patients). The median estimated systolic pulmonary artery pressure in patients with PH was 38.8 mmHg. COPD patients with PH were older, had a lower body mass index, scored worse in the COPD Assessment Test and St. George’s Respiratory Questionnaire, and exhibited a lower diffusing capacity of the lung for carbon monoxide in comparison to patients without PH. In computed tomography images, the percentages of low-attenuation areas (LAA%) and interstitial abnormalities were higher in COPD patients with PH than in those without PH. Higher values for LAA% (LAA ≥ 30%) and interstitial abnormalities independently increased the risk of PH. The ratio of main pulmonary diameter to aortic artery diameter was significantly correlated with estimated systolic pulmonary artery pressure. In the follow-up analysis, the frequency of exacerbations in three years was significantly higher in patients with PH compared to patients without PH.
Conclusion: In this study, we identified the clinical characteristics of COPD patients with PH detected by echocardiography. The presence of PH assessed by echocardiography was related to future COPD exacerbations and closely related to radiographical emphysema.
Keywords: comorbidity, COPD, echocardiography, pulmonary hypertension
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