title: Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Pulmonary vascular findings are largely unreported in end-stage chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Pulmonary vascular lesions in explanted lungs from 70 patients with COPD/emphysema or α-1-antitrypsin deficiency were analyzed retrospectively. Patients were stratified by the presence and severity of pulmonary hypertension (PH) assessed by right-heart catheterization in 3 hemodynamically distinct groups: (1) non-PH (mean pulmonary arterial pressure [mPAP]<25 mm Hg), (2) mild to moderate PH (mPAP, 25-34 mm Hg), and (3) severe PH (mPAP≥35 mm Hg). The control group comprised 18 patients with idiopathic pulmonary arterial hypertension (IPAH). Vascular lesions were graded 1-6 according to a modified Heath and Edwards (HE) scale.
  
  
  RESULTS
  All COPD patients were in New York Heart Association Functional Class III-IV (forced expiratory volume in 1 second, 23%±8%; total lung capacity, 128%±20% of predicted). Non-PH group: 30 patients (60% women) aged 54±6 years; mPAP, 17.2±3.8 mm Hg; median HE Grade 1 (range, 0-3), with medial hypertrophy of muscular pulmonary arteries and muscularization of pulmonary arterioles. Mild-moderate PH group: 30 patients (50% women) aged 53±6 years; mPAP, 28.6±2.8 mm Hg; median HE Grade 3 (range, 1-3), with additional cellular intimal proliferation. Severe PH group: 10 patients (50% women) aged 54±6 years; mPAP, 40.7±5.2 mm Hg; median HE Grade 3 (range, 2-5), with additional intimal fibrosis. IPAH controls: 18 patients (67% women) aged 36±4 years; mPAP,>50 mm Hg; median HE Grade 4 (range 3-6), with generalized arterial dilatation and plexiform lesions.
  
  
  CONCLUSIONS
  The extent of pulmonary vascular lesions in COPD correlate with the severity of PH. Morphologic lesions similar to those characteristic of IPAH can be observed as PH in COPD progresses to levels characteristic of IPAH.
authors.affiliation: Department of Cardiology, Pulmonary Vascular Program, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. carlsen@rh.dk
authors.forename: Jørn
authors.initials: J
authors.lastname: Carlsen
authors.forename: Kasper
authors.initials: K
authors.lastname: Hasseriis Andersen
authors.forename: Søren
authors.initials: S
authors.lastname: Boesgaard
authors.forename: Martin
authors.initials: M
authors.lastname: Iversen
authors.forename: Daniel
authors.initials: D
authors.lastname: Steinbrüchel
authors.forename: Claus
authors.initials: C
authors.lastname: Bøgelund Andersen
mesh_terms: D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology*; D011651:Pulmonary Artery / Q000473:pathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index