Steger Mathilde, Canuet Matthieu, Martin Guillaume, Labani Aissam, Schwartz Jean Charles, Enache Irina, Schuller Armelle, Meyer Léo, Chaouat Ari, Kessler Romain, Montani David, Riou Marianne
Chest Diseases Department, Nouvel hôpital civil, University Hospital of Strasbourg, Strasbourg, France.
Radiology Department, Nouvel hôpital civil, University Hospital of Strasbourg, Strasbourg, France.
ERJ Open Res. 2025 Mar 24;11(2). doi: 10.1183/23120541.00716-2024. eCollection 2025 Mar.
Pulmonary hypertension (PH) associated with COPD (PH-COPD) exhibits diverse phenotypes, challenging therapeutic management. This study aimed to describe the characteristics of COPD patients with distinct phenotypes, namely end-stage COPD with or without PH (group 1), other COPD patients with mild-to-moderate pre-capillary PH-COPD (group 2) and COPD patients with a pulmonary vascular phenotype (PVP) (group 3).
We performed a retrospective analysis of COPD patients who underwent right heart catheterisation from 2015 to 2022.
81 patients were included in group 1, 37 in group 2 and 35 in group 3. The groups differed in terms of clinical, functional, haemodynamic and imaging characteristics. Group 1 had significantly marked lung hyperinflation with increased total lung capacity and residual volume, a feature not observed in group 3. These results were confirmed by analysis of chest CT scans, which confirmed varying degrees of emphysema, as follows: severe in group 1, moderate in group 2 and mild in group 3, with median total emphysema indices of 55% (48-62), 32% (16-49) and 16% (3.4-31), respectively, p<0.0001.
Our results highlight the broad spectrum of PH in COPD, from PH associated with end-stage COPD (phenotype/group 1), characterised by predominant alveolar wall damage with severe emphysema, to PVP (phenotype/group 3), mainly due to pulmonary vascular changes. Phenotype/group 2 represents an intermediate state combining features of both. In the current debate on how to distinguish PH-COPD phenotypes, it might be of interest to include quantitative thresholds for emphysema in future diagnostic and management algorithms.
与慢性阻塞性肺疾病（COPD）相关的肺动脉高压（PH）表现出多种表型，给治疗管理带来挑战。本研究旨在描述具有不同表型的COPD患者的特征，即终末期COPD伴或不伴PH（第1组）、其他患有轻度至中度毛细血管前PH-COPD的COPD患者（第2组）和具有肺血管表型（PVP）的COPD患者（第3组）。
我们对2015年至2022年接受右心导管检查的COPD患者进行了回顾性分析。
第1组纳入81例患者，第2组纳入37例患者，第3组纳入35例患者。三组在临床、功能、血流动力学和影像学特征方面存在差异。第1组有明显的肺过度充气，肺总量和残气量增加，这一特征在第3组未观察到。胸部CT扫描分析证实了这些结果，其证实了不同程度的肺气肿，如下：第1组为重度，第2组为中度，第3组为轻度，肺气肿总指数中位数分别为55%（48-62）、32%（16-49）和16%（3.4-31），p<0.0001。
我们的结果突出了COPD中PH的广泛谱系，从与终末期COPD相关的PH（表型/第1组），其特征为以严重肺气肿为主的肺泡壁损伤，到PVP（表型/第3组），主要由于肺血管变化。表型/第2组代表了两者特征相结合的中间状态。在当前关于如何区分PH-COPD表型的争论中，在未来的诊断和管理算法中纳入肺气肿的定量阈值可能会很有意义。
