title: Clinical characteristics and prediction of pulmonary hypertension in severe emphysema.
abstract: BACKGROUND
  We explored the prevalence, clinical and physiologic correlates of pulmonary hypertension (PH), and screening strategies in patients with severe emphysema evaluated for the National Emphysema Treatment Trial (NETT).
  
  
  METHODS
  Patients undergoing Doppler echocardiography (DE) and right heart catheterization were included. Patients with mean pulmonary arterial pressure ≥ 25 mmHg (PH Group) were compared to the remainder (non-PH Group).
  
  
  RESULTS
  Of 797 patients, 302 (38%) had PH and 18 (2.2%) had severe PH. Compared to the non-PH Group, patients with PH had lower % predicted FEV1 (p < 0.001), % predicted diffusion capacity for carbon monoxide (p = 0.006), and resting room air PaO2 (p < 0.001). By multivariate analysis, elevated right ventricular systolic pressure, reduced resting room air PaO2, reduced post-bronchodilator % predicted FEV1, and enlarged pulmonary arteries on computed tomographic scan were the best predictors of PH. A strategy using % predicted FEV1, % predicted DLCO, PaO2, and RVSP was predictive of the presence of pre-capillary PH and was highly predictive of its absence.
  
  
  CONCLUSIONS
  Mildly elevated pulmonary artery pressures are found in a significant proportion of patients with severe emphysema. However, severe PH is uncommon in the absence of co-morbidities. Simple non-invasive tests may be helpful in screening patients for pre-capillary PH in severe emphysema but none is reliably predictive of its presence.
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, USA. Electronic address: minaio@ccf.org.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Minai
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, USA. Electronic address: hfessler@jhmi.edu.
authors.forename: Henry
authors.initials: H
authors.lastname: Fessler
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, USA. Electronic address: stollej@ccf.org.
authors.forename: James K
authors.initials: JK
authors.lastname: Stoller
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Temple University, USA. Electronic address: Gerard.Criner@tuhs.temple.edu.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Criner
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland, USA. Electronic address: sscharf@medicine.umaryland.edu.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Scharf
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, USA. Electronic address: meliy@ccf.org.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Meli
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, USA. Electronic address: nutteb@ccf.org.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nutter
authors.affiliation: Division of Thoracic Surgery, Northwestern University, USA. Electronic address: mdecamp@nmh.org.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
mesh_terms: D000368:Aged; D002248:Carbon Monoxide / Q000032:analysis; D015897:Comorbidity; D015150:Echocardiography, Doppler; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis; D015995:Prevalence; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011656:Pulmonary Emphysema / Q000453:epidemiology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
chemical_list: D002248:Carbon Monoxide; D010100:Oxygen
keywords: Chronic obstructive pulmonary disease; Emphysema; Hypoxemia; Lung disease; Pulmonary hypertension