Severe pulmonary hypertension associated with COPD: hemodynamic improvement with specific therapy.
BACKGROUND
There is no recommendation for treating pulmonary hypertension (PH) when associated with chronic obstructive pulmonary disease (COPD).


OBJECTIVE
To evaluate the effect of PH-specific therapy in patients with COPD.


METHODS
All successive patients with severe PH [mean pulmonary arterial pressure (mPAP) ≥35 mm Hg] and COPD, who received specific PH medication and who underwent right heart catheterization at baseline and after 3-12 months of treatment, were analyzed from a prospective database.


RESULTS
Twenty-six patients were included with a median follow-up of 14 months. Mean forced expiratory volume in 1 s was 57 ± 20% of predicted, and mean forced expiratory volume in 1 s/forced vital capacity was 47 ± 12%. Dyspnea was New York Health Association classification stage (NYHA) II in 15%, NYHA III in 81% and NYHA IV in 4%. First-line treatments were endothelin receptor antagonists in 11 patients, phosphodiesterase-5 inhibitors in 11 patients, calcium blocker in 1 patient, combination therapy in 3 patients including 2 with a prostanoid. After 6 ± 3 months, pulmonary vascular resistance decreased from 8.5 ± 3 to 6.6 ± 2 Wood units (p < 0.001), with significant improvement of cardiac index from 2.44 ± 0.43 to 2.68 ± 0.63 liters × min × m-2 (p = 0.015) and mPAP from 48 ± 9 to 42 ± 10 mm Hg (p = 0.008). There was no significant difference in dyspnea, 6-min walking distance, echocardiographic parameters or N-terminal pro-brain natriuretic peptide levels. There was no significant difference in arterial oxygen saturation after 3-12 months of treatment.


CONCLUSIONS
Specific PH medications may improve hemodynamic parameters in COPD patients with severe PH. Appropriate prospective randomized studies are needed to evaluate the potential long-term clinical benefit of treatment.
Service de Pneumologie, Centre de Compx00E9;tences des Maladies Pulmonaires Rares, Centre de Compx00E9;tences de l'Hypertension Pulmonaire, Universitx00E9; de Rennes 1, Rennes, France.
Anne
A
Girard
Stephane
S
Jouneau
Céline
C
Chabanne
Chahéra
C
Khouatra
Morgane
M
Lannes
Julie
J
Traclet
Ségolène
S
Turquier
P
P
Delaval
J-F
JF
Cordier
Vincent
V
Cottin
D000368:Aged; D000077300:Bosentan; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006439:Hemodynamics / Q000502:physiology; D006785:Hospitals, University; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D013449:Sulfonamides / Q000627:therapeutic use; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects*; D014665:Vasodilator Agents / Q000627:therapeutic use
D013449:Sulfonamides; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D000077300:Bosentan