title: Pulmonary hemodynamic profile in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Few data are available in regards to the prevalence of pulmonary hypertension (PH) in the broad spectrum of COPD. This study was aimed at assessing the prevalence of PH in a cohort of COPD patients across the severity of airflow limitation, and reporting the hemodynamic characteristics at rest and during exercise.
  
  
  METHODS
  We performed a retrospective analysis on COPD patients who underwent right-heart catheterization in our center with measurements obtained at rest (n=139) and during exercise (n=85). PH was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg and pulmonary capillary wedge pressure <15 mmHg. Exercise-induced PH (EIPH) was defined by a ratio of ΔmPAP/Δcardiac output >3.
  
  
  RESULTS
  PH was present in 25 patients (18%). According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, PH prevalence in GOLD 2 was 7% (3 patients); 25% (14 patients) in GOLD 3; and 22% (8 patients) in GOLD 4. Severe PH (mPAP ≥35 mmHg) was identified in four patients (2.8%). Arterial partial oxygen pressure was the outcome most strongly associated with PH (r=-0.29, P<0.001). EIPH was observed in 60 patients (71%) and had a similar prevalence in both GOLD 2 and 3, and was present in all GOLD 4 patients. Patients with PH had lower cardiac index during exercise than patients without PH (5.0±1.2 versus 6.7±1.4 L/min/m(2), respectively; P=0.001).
  
  
  CONCLUSIONS
  PH has a similar prevalence in COPD patients with severe and very-severe airflow limitation, being associated with the presence of arterial hypoxemia. In contrast, EIPH is highly prevalent, even in moderate COPD, and might contribute to limiting exercise tolerance.
authors.affiliation: Department of PulmonaryMedicine, Hospital Clínic-Institut d'Investigacions Biomèdiques AugustPi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Karina
authors.initials: K
authors.lastname: Portillo
authors.affiliation: Department of PulmonaryMedicine, Hospital Clínic-Institut d'Investigacions Biomèdiques AugustPi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain ; Centrode Investigación Biomédica enRed de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Torralba
authors.affiliation: Department of PulmonaryMedicine, Hospital Clínic-Institut d'Investigacions Biomèdiques AugustPi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain ; Centrode Investigación Biomédica enRed de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Blanco
authors.affiliation: Department of PulmonaryMedicine, Hospital Clínic-Institut d'Investigacions Biomèdiques AugustPi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain ; Centrode Investigación Biomédica enRed de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Felip
authors.initials: F
authors.lastname: Burgos
authors.affiliation: Department of PulmonaryMedicine, Hospital Clínic-Institut d'Investigacions Biomèdiques AugustPi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain ; Centrode Investigación Biomédica enRed de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rodriguez-Roisin
authors.affiliation: Biostatistics and Data Management Core Facility, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Biostatistics Unit, Schoolof Medicine, Universitat Autònomade Barcelona, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rios
authors.affiliation: Department of PulmonaryMedicine, Hospital Clínic-Institut d'Investigacions Biomèdiques AugustPi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain ; Centrode Investigación Biomédica enRed de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.affiliation: Department of PulmonaryMedicine, Hospital Clínic-Institut d'Investigacions Biomèdiques AugustPi iSunyer (IDIBAPS), University of Barcelona, Barcelona, Spain ; Centrode Investigación Biomédica enRed de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Barberà
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D008168:Lung / Q000098:blood supply* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011651:Pulmonary Artery / Q000503:physiopathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013147:Spirometry
keywords: GOLD; cardiac index; pulmonary hypertension; right heart catheterization