title: Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation.
abstract: OBJECTIVE
  To assess the pulmonary hemodynamic characteristics in COPD candidates for lung volume reduction surgery (LVRS) or lung transplantation (LT).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  One center in France.
  
  
  METHODS
  Two hundred fifteen patients with severe COPD who underwent right-heart catheterization before LVRS or LT.
  
  
  RESULTS
  Mean age was 54.6 years. Pulmonary function test results were as follows: FEV(1), 24.3% predicted; total lung capacity, 128.3% predicted; residual volume, 259.7% predicted. Mean pulmonary artery pressure (PAPm) was 26.9 mm Hg. Pulmonary hypertension (PAPm > 25 mm Hg) was present in 50.2% and was moderate (PAPm, 35 to 45 mm Hg) or severe (PAPm > 45 mm Hg) in 9.8% and in 3.7% of patients, respectively. Cardiac index was low normal. PAPm was related to Pao(2) and alveolar-arterial oxygen gradient in multivariate analysis. Cluster analysis identified a subgroup of atypical patients (n = 16, 7.4%) characterized by moderate impairment of the pulmonary mechanics (mean FEV(1), 48.5%) contrasting with high level of pulmonary artery pressure (PAPm, 39.8 mm Hg), and severe hypoxemia (mean Pao(2), 46.2 mm Hg).
  
  
  CONCLUSIONS
  While pulmonary hypertension is observed in half of the COPD patients with advanced disease, moderate-to-severe pulmonary hypertension is not a rare event in these patients. We individualized a subgroup of patients presenting with a predominant vascular disease that could potentially benefit from vasodilators.
authors.affiliation: Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 B du Général Leclerc 92110, Clichy, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Dauriat
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Stern
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.forename: Antoine
authors.initials: A
authors.lastname: Lévy
authors.forename: Rolana
authors.initials: R
authors.lastname: Marrash-Chahla
authors.forename: Hervé
authors.initials: H
authors.lastname: Mal
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D012129:Respiratory Function Tests; D012189:Retrospective Studies