Pulmonary Hypertension Unit, Department of Cardiovascular and Respiratory Diseases, Sapienza University of Rome, Rome, Italy.
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; German Center of Lung Research (DZL), Germany.
Chest. 2021 Aug;160(2):678-689. doi: 10.1016/j.chest.2021.02.012. Epub 2021 Feb 11.
Pulmonary hypertension (PH) in COPD is a poorly investigated clinical condition.
Which factors determine the outcome of PH in COPD?
We analyzed the characteristics and outcome of patients enrolled in the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) with moderate or severe PH in COPD as defined during the 6th PH World Symposium who received medical therapy for PH and compared them with patients with idiopathic pulmonary arterial hypertension (IPAH).
The population included incident patients with moderate PH in COPD (n = 68), with severe PH in COPD (n = 307), and with IPAH (n = 489). Patients with PH in COPD were older, predominantly male, and treated mainly with phosphodiesterase-5 inhibitors. Despite similar hemodynamic impairment, patients with PH in COPD achieved a worse 6-min walking distance (6MWD) and showed a more advanced World Health Organization functional class (WHO FC). Transplant-free survival rates at 1, 3, and 5 years were higher in the IPAH group than in the PH in COPD group (IPAH: 94%, 75%, and 55% vs PH in COPD: 86%, 55%, and 38%; P = .004). Risk factors for poor outcomes in PH in COPD were male sex, low 6MWD, and high pulmonary vascular resistance (PVR). In patients with severe PH in COPD, improvements in 6MWD by ≥ 30 m or improvements in WHO FC after initiation of medical therapy were associated with better outcomes.
Patients with PH in COPD were functionally more impaired and had a poorer outcome than patients with IPAH. Predictors of death in the PH in COPD group were sex, 6MWD, and PVR. Our data raise the hypothesis that some patients with severe PH in COPD may benefit from PH treatment. Randomized controlled studies are necessary to explore this hypothesis further.
ClinicalTrials.gov; No.: NCT01347216; URL: www.clinicaltrials.gov.
慢性阻塞性肺疾病（COPD）合并肺动脉高压（PH）是一种研究较少的临床病症。
哪些因素决定了 COPD 合并 PH 的患者的预后？
我们分析了在第六届肺动脉高压世界研讨会期间被定义为中度或重度 PH 的 COPD 患者，他们在接受 PH 治疗时被纳入比较、前瞻性的新疗法登记处（COMPERA）的特征和结局，并将他们与特发性肺动脉高压（IPAH）患者进行比较。
该人群包括中度 COPD 合并 PH 的新发患者（n=68）、重度 COPD 合并 PH 的患者（n=307）和 IPAH 患者（n=489）。COPD 合并 PH 的患者年龄较大，主要为男性，主要接受磷酸二酯酶-5 抑制剂治疗。尽管存在相似的血液动力学损害，但 COPD 合并 PH 的患者 6 分钟步行距离（6MWD）更差，且世界卫生组织功能分级（WHO FC）更差。1、3 和 5 年时 IPAH 组的无移植生存率高于 COPD 合并 PH 组（IPAH：94%、75%和 55%vs COPD 合并 PH：86%、55%和 38%；P=0.004）。COPD 合并 PH 患者预后不良的危险因素是男性、6MWD 低和肺血管阻力（PVR）高。在重度 COPD 合并 PH 的患者中，药物治疗开始后 6MWD 改善≥30m 或 WHO FC 改善与更好的结局相关。
COPD 合并 PH 的患者在功能上比 IPAH 患者受损更严重，预后更差。COPD 合并 PH 组死亡的预测因素是性别、6MWD 和 PVR。我们的数据提出了这样一种假设，即一些重度 COPD 合并 PH 的患者可能受益于 PH 治疗。需要随机对照研究进一步探索这一假设。
ClinicalTrials.gov；编号：NCT01347216；网址：www.clinicaltrials.gov。
