Department of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain.
Medicine and Translational Research, University of Barcelona, Barcelona, Spain.
Respiration. 2022;101(8):717-727. doi: 10.1159/000524263. Epub 2022 Apr 22.
The impact of the new "borderline" hemodynamic class for pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP], 21-24 mm Hg and pulmonary vascular resistance, [PVR], ≥3 wood units, [WU]) in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is unclear.
The aim of this study was to assess the effect of borderline PH (BLPH) on survival in COPD and ILD patients.
Survival was analyzed from retrospective data from 317 patients in 12 centers (Italy, Spain, UK) comparing four hemodynamic groups: the absence of PH (NoPH; mPAP <21 mm Hg or 21-24 mm Hg and PVR <3 WU), BLPH (mPAP 21-24 mm Hg and PVR ≥3 WU), mild-moderate PH (MPH; mPAP 25-35 mm Hg and cardiac index [CI] ≥2 L/min/m2), and severe PH (SPH; mPAP ≥35 mm Hg or mPAP ≥25 mm Hg and CI <2 L/min/m2).
BLPH affected 14% of patients; hemodynamic severity did not predict survival when COPD and ILD patients were analyzed together. However, survival in the ILD cohort for any PH level was worse than in NoPH (3-year survival: NoPH 58%, BLPH 32%, MPH 28%, SPH 33%, p = 0.002). In the COPD cohort, only SPH had reduced survival compared to the other groups (3-year survival: NoPH 82%, BLPH 86%, MPH 87%, SPH 57%, p = 0.005). The mortality risk correlated significantly with mPAP in ILD (hazard ratio [HR]: 2.776, 95% CI: 2.057-3.748, p < 0.001) and notably less in COPD patients (HR: 1.015, 95% CI: 1.003-1.027, p = 0.0146).
In ILD, any level of PH portends worse survival, while in COPD, only SPH presents a worse outcome.
新的肺动脉高压（PH）“边界”血液动力学分类（平均肺动脉压 [mPAP]，21-24mmHg 和肺血管阻力 [PVR]，≥3 伍德单位 [WU]）对慢性阻塞性肺疾病（COPD）和间质性肺疾病（ILD）的影响尚不清楚。
本研究旨在评估边界 PH（BLPH）对 COPD 和 ILD 患者生存的影响。
对来自意大利、西班牙和英国 12 个中心的 317 例患者的回顾性数据进行生存分析，比较了 4 个血液动力学组：无 PH（NoPH；mPAP<21mmHg 或 21-24mmHg 和 PVR<3WU）、BLPH（mPAP 21-24mmHg 和 PVR≥3WU）、轻度中度 PH（MPH；mPAP 25-35mmHg 和心指数 [CI]≥2L/min/m2）和严重 PH（SPH；mPAP≥35mmHg 或 mPAP≥25mmHg 和 CI<2L/min/m2）。
BLPH 影响了 14%的患者；当 COPD 和 ILD 患者一起分析时，血液动力学严重程度并不能预测生存。然而，ILD 患者的任何 PH 水平的生存率均低于 NoPH（3 年生存率：NoPH 58%，BLPH 32%，MPH 28%，SPH 33%，p=0.002）。在 COPD 组中，只有 SPH 的生存率低于其他组（3 年生存率：NoPH 82%，BLPH 86%，MPH 87%，SPH 57%，p=0.005）。ILD 患者的死亡率与 mPAP 显著相关（危险比 [HR]：2.776，95%CI：2.057-3.748，p<0.001），而 COPD 患者的相关性显著降低（HR：1.015，95%CI：1.003-1.027，p=0.0146）。
在 ILD 中，任何程度的 PH 都预示着更差的生存率，而在 COPD 中，只有 SPH 表现出更差的预后。
