Study the different phenotypes of pulmonary hypertension and their associated factors in chronic obstructive pulmonary disease patients

Abstract

Background
A unified approach to diagnosing and treating pulmonary hypertension (PH) is essential to improving the patients' quality of life and prognosis in terms of therapeutic considerations, as it is often underdiagnosed and under-evaluated in patients with chronic obstructive pulmonary disease (COPD) and is linked to a high mortality rate from complications like cor-pulmonale.


Methods
An analytical cross-sectional study was carried out at Beni-Suef University Hospital's Chest Department, on 94 COPD patients from December 2022 to May 2024. All the patients underwent clinical history, physical examination, 6-minute walk test, laboratory investigations, Spirometry, HRCT, and transthoracic echocardiography. Patients with severely elevated systolic pulmonary artery pressure underwent right heart catheterization using Swan-Ganz catheter.


Results
The prevalence of PH estimated by Echocardiography in our study group was 49%(46 of 94). Amongst theses mild PH was noted in 18 patients (39.2%), moderate in 6 (13%), and severe in 22 (47.8%), The PH prevalence was 47.8% in moderate COPD( 11 of 23 cases: 3 mild, 4 moderate and 4 severe) and 49.29% in severe to very severe COPD ( 35 of 71 cases: 15 mild, 2 moderate and 18 severe]. PH Phenotypes were stratified as follow: Mild to moderate PH (group 3), Severe PH and serve obstruction ( group 3), Severe PH by echocardiography with mild to moderate obstruction & cardiac comorbidity( group 3) and PH with left heart disease due to cardiomyopathy or diastolic dysfunction (group 2: 11 cases, or 24% of echocardiographic PH cases) [1]. Regression analysis revealed that for each unit decrease in Tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure (sPAP) increase by 2.36 times; for each unit increase in TAPSI/PAPSI there will be decrease in sPAP by 1.09 times.


Conclusion
49% of the COPD patients in the study had PH. Additionally, as the severity of COPD grew, so did the frequency and severity of PH. Hypoxemia and decreased TAPSE are predictive of prognosis and are associated with the severity of the disease in COPD.