Observing Alterations on Right Side of Heart Reveals COPD-Related PH Best

Results from a recent study published in the Egyptian Journal of Chest Diseases and Tuberculosis suggest that Pulmonary hypertension (PH) in patients with Chronic Obstructive Pulmonary Disease (COPD) is a common co-morbidity along with right sided cardiac changes. Based on the findings, the researchers suggest that Echocardiography should be used with caution during assessment of pulmonary artery systolic pressure (PASP). In the study, COPDPH patients were also found to have worse prognosis than COPD patients without PH.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable affliction that causes persistent limitations in airflow. The condition is progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases. Pulmonary hypertension (PH) is considered one of the common complications of COPD-associated PH (COPDPH), increasingly recognized as a poor prognostic marker. It is not only associated with an increased risk of exacerbations but also associated with worsened exercise capacity, oxygenation and mortality. Diagnosis is complex with criteria differing in the RHC pressures and echocardiographic thresholds, however, right heart catheterization (RHC) is essential for a definitive diagnosis.

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In their study titled “Detection of right sided heart changes and pulmonary hypertension in COPD patients,” Karim Mahmod and colleagues from the Cardiology Department, Cairo University in Egypt assessed the heart’s right side function with a diagnosis of pulmonary hypertension and examined hemodynamic abnormalities, to understand the limitations of pulmonary hypertension in patients with COPD.

A total of 51 patients with COPD were enrolled in the study. The researchers gathered information of PFTs (post bronchodilators FEV1 ⩽ 0.7), echo, BODE index. After echo results showing PASP ⩾ 45 mmHg. A total of 17 patients underwent RHC.

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Results revealed that patients who suffer from PH with COPD have more co-morbidities than COPD alone. Patients with COPDPH were found to be more hyperemic and had more severe airway obstruction. In addition, the results demonstrated that right side changes and PH in COPD patients are common complications, affecting survival and limiting exercise capacity.

The study also detected that ECHO heart sensitivity was about 65%, with 64.7% of the patients having>10 mmHg difference between PASP calculated by echo and measured by RHC. The researchers concluded that this approach may be used as a noninvasive screening method, but the results should be interpreted carefully in COPD patients.