Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation.
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.
Thabut
Gabriel
G
Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 B du Général Leclerc 92110, Clichy, France.
Dauriat
Gaëlle
G
Stern
Jean Baptiste
JB
Logeart
Damien
D
Lévy
Antoine
A
Marrash-Chahla
Rolana
R
Mal
Hervé
H
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