title: Echocardiographic evidence of pulmonary hypertension is associated with increased 1-year mortality in patients admitted with chronic obstructive pulmonary disease.
abstract: Pulmonary hypertension (PH) is associated with decreased overall survival in patients with chronic lung disease. The purpose of this study was to determine the effect of echocardiographic evidence of PH on 1-year survival in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (COPD). This is a retrospective study of patients admitted to a respiratory intermediate care unit with COPD exacerbation between October 1, 2002 and September 30, 2004. All patients who had 2D echocardiograms and pulmonary function tests done within 12 months prior to hospital admission or during the admission were examined. Charts were reviewed for the following outcomes: length of hospital stay, need for mechanical ventilation, survival at discharge, and mortality over the next year. Data were analyzed using multiple logistic regression and p values calculated using Fisher's exact test. Forty-three patients met study entry criteria, and PH, defined as systolic right ventricular pressure greater than 45 mmHg, was found in 23 (53%). Sixteen of the 23 patients (70%) with PH died during the 1-year follow-up period compared to 5 of 20 (25%) patients with no PH (p = 0.0058). The effect of PH on survival was independent of age, forced expiratory volume in 1 s (FEV(1)), arterial pH, pCO(2), or pO(2) (p < 0.01). Echocardiographic evidence of PH is associated with increased 1-year mortality in patients admitted with COPD exacerbation. Further studies are needed to determine if PH is a cause of increased mortality in this population or an indicator of other cardiovascular disease.
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital, Providence, RI 02903, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stone
authors.forename: Jason T
authors.initials: JT
authors.lastname: Machan
authors.forename: Jeffery
authors.initials: J
authors.lastname: Mazer
authors.forename: Brian
authors.initials: B
authors.lastname: Casserly
authors.forename: James R
authors.initials: JR
authors.lastname: Klinger
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D007902:Length of Stay; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right; D017725:Ventricular Pressure