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Echocardiographic Evidence of Pulmonary Hypertension is Associated with Increased 1-year Mortality in Patients Admitted with Chronic Obstructive Pulmonary Disease

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Abstract

Pulmonary hypertension (PH) is associated with decreased overall survival in patients with chronic lung disease. The purpose of this study was to determine the effect of echocardiographic evidence of PH on 1-year survival in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (COPD). This is a retrospective study of patients admitted to a respiratory intermediate care unit with COPD exacerbation between October 1, 2002 and September 30, 2004. All patients who had 2D echocardiograms and pulmonary function tests done within 12 months prior to hospital admission or during the admission were examined. Charts were reviewed for the following outcomes: length of hospital stay, need for mechanical ventilation, survival at discharge, and mortality over the next year. Data were analyzed using multiple logistic regression and p values calculated using Fisher’s exact test. Forty-three patients met study entry criteria, and PH, defined as systolic right ventricular pressure greater than 45 mmHg, was found in 23 (53%). Sixteen of the 23 patients (70%) with PH died during the 1-year follow-up period compared to 5 of 20 (25%) patients with no PH (p = 0.0058). The effect of PH on survival was independent of age, forced expiratory volume in 1 s (FEV1), arterial pH, pCO2, or pO2 (p < 0.01). Echocardiographic evidence of PH is associated with increased 1-year mortality in patients admitted with COPD exacerbation. Further studies are needed to determine if PH is a cause of increased mortality in this population or an indicator of other cardiovascular disease.

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Abbreviations

BMI:

Body mass index

COPD:

Chronic obstructive pulmonary disease

FEV1 :

Forced expiratory volume in one second

GOLD:

Global Initiative for Chronic Obstructive Lung Disease

ICD9:

International Classification of Diseases

mmHg:

Millimeters of mercury

PAP:

Pulmonary arterial pressure

mPAP:

Mean pulmonary arterial pressure

PAH:

Pulmonary arterial hypertension

pCO2 :

Partial pressure of carbon dioxide

PFT:

Pulmonary function test

PH:

Pulmonary hypertension

pO2 :

Partial pressure of oxygen

RAP:

Right atrial pressure

RV:

Right ventricle

RVSP:

Right ventricular systolic pressure

sPAP:

Systolic pulmonary artery pressure

TR:

Tricuspid regurgitation

TRV:

Tricuspid regurgitant velocity

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Acknowledgment

This study was supported by AHA Established Investigator Grant HN 240914 (JRK).

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Authors and Affiliations

  1. Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA

    Andrew C. Stone, Jason T. Machan, Jeffery Mazer & James R. Klinger

  2. Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908, USA

    Andrew C. Stone & James R. Klinger

  3. The Alpert Medical School of Brown University, 97 Waterman Street, Providence, RI, 02912, USA

    Andrew C. Stone, Jason T. Machan, Jeffery Mazer, Brian Casserly & James R. Klinger

  4. Division of Pulmonary Medicine, The Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI, 02860, USA

    Brian Casserly

  5. Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA

    James R. Klinger

Authors
  1. Andrew C. Stone
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  2. Jason T. Machan
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  3. Jeffery Mazer
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  4. Brian Casserly
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  5. James R. Klinger
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Corresponding author

Correspondence to James R. Klinger.

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Stone, A.C., Machan, J.T., Mazer, J. et al. Echocardiographic Evidence of Pulmonary Hypertension is Associated with Increased 1-year Mortality in Patients Admitted with Chronic Obstructive Pulmonary Disease. Lung 189, 207–212 (2011). https://doi.org/10.1007/s00408-011-9293-4

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  • DOI: https://doi.org/10.1007/s00408-011-9293-4

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