Chest
Original Research: Pulmonary and CardiovascularDiffusing Capacity Is an Independent Predictor of Outcomes in Pulmonary Hypertension Associated With COPD
Section snippets
Study Population and Design
This retrospective cohort study examined patients with COPD-PH who were enrolled in the Johns Hopkins Pulmonary Hypertension Registry, an Institutional Review Board-approved registry of patients seen at Johns Hopkins University, Baltimore, MD. All patients enrolled in the registry provide written informed consent for data collection.
From January 2000 to January 2018, 95 participants were identified on initial screening for patients enrolled with COPD designated as the primary cause for their
Characteristics of a Patient With COPD-PH
Baseline characteristics for all 71 patients with COPD-PH are described in Table 1. Patients were on average 65 years old, 66% female, with BMI of 28.3 kg/m2, and 44 pack-years smoked. Approximately three-quarters of them used supplemental oxygen, and nearly 60% were World Health Organization Functional Classification III/IV at index catheterization. PFT demonstrated moderate-severe obstruction (FEV1 52±20%), with severe gas transfer defects (Dlco 43±20%), and severely impaired 6MWD (265±124
Discussion
In a cohort of patients with COPD-PH from a PH tertiary referral center, we have demonstrated that (1) overall prognosis is poor among this population, (2) airflow obstruction does not predict death, and (3) gas transfer is a strong independent predictor of death. Gas transfer was observed to be the only significant predictor of death, after accounting for airflow obstruction and hemodynamics, with a 4% increase in mortality rate for every 1% decrease in Dlco. In the context of increasing
Acknowledgments
Author contributions: S. C. M. contributed to the conception, design of the study, data analysis, interpretation, and preparation of this manuscript and is the guarantor of this paper. A. B. contributed to the conception, design of the study, data analysis, interpretation, and manuscript writing. T. M. K., R. L. D., P. M. H., and M. C. M. contributed to data interpretation and revision of the manuscript. All authors reviewed and approved the manuscript prior to submission for publication.
References (65)
- et al.
Pulmonary hypertension in COPD: epidemiology, significance, and management: pulmonary vascular disease: the global perspective
Chest
(2010) - et al.
Prognostic factors in COPD patients receiving long-term oxygen therapy
Chest
(1995) - et al.
Clinical characteristics and prediction of pulmonary hypertension in severe emphysema
Respir Med
(2014) - et al.
Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease
J Heart Lung Transplant
(2012) - et al.
GOLD 2011 disease severity classification in COPDGene: a prospective cohort study
Lancet Respir Med
(2013) - et al.
Diffusing capacity of carbon monoxide in assessment of chronic obstructive pulmonary disease
Chest
(2019) - et al.
Carbon monoxide diffusing capacity and mortality in pulmonary arterial hypertension
J Heart Lung Transplant
(2010) - et al.
Diffusion capacity and mortality in patients with pulmonary hypertension due to heart failure with preserved ejection fraction
JACC Heart Fail
(2016) - et al.
Survival in pulmonary hypertension due to chronic lung disease: influence of low diffusion capacity of the lungs for carbon monoxide
J Heart Lung Transplant
(2019) - et al.
Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis
Chest
(2007)
A simulation study of the number of events per variable in logistic regression analysis
J Clin Epidemiol
Pulmonary hypertension in chronic lung diseases
J Am Coll Cardiol
The Giessen Pulmonary Hypertension Registry: survival in pulmonary hypertension subgroups
J Heart Lung Transplant
Relationships between diffusing capacity for carbon monoxide (Dlco), and quantitative computed tomography measurements and visual assessment for chronic obstructive pulmonary disease
Eur J Radiol
Pulmonary vascular abnormalities in chronic obstructive pulmonary disease undergoing lung transplant
J Heart Lung Transplant
Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease
J Heart Lung Transplant
Pulmonary arterial histologic lesions in patients with COPD with severe pulmonary hypertension
Chest
Lung function abnormalities are highly frequent in patients with heart failure and preserved ejection fraction
Heart Lung Circ
Pulmonary diffusing capacity in left ventricular dysfunction
Chest
New predictors of outcome in idiopathic pulmonary arterial hypertension
Am J Cardiol
Pulmonary function testing in patients with pulmonary arterial hypertension
Respir Med
Predicting survival in patients with pulmonary arterial hypertension: The REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies
Chest
Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation
Chest
Mortality in the United States, 2016
NCHS Data Brief
Employment and activity limitations among adults with chronic obstructive pulmonary disease: United States, 2013
MMWR Morb Mortal Wkly Rep
“Natural history” of pulmonary hypertension in a series of 131 patients with chronic obstructive lung disease
Am J Respir Crit Care Med
Pulmonary hypertension in COPD
Euro Respir J
Severe pulmonary hypertension and chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Long-term course of pulmonary arterial pressure in chronic obstructive pulmonary disease
Am Rev Respir Dis
Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease
Am J Respir Crit Care Med
Admission for COPD exacerbation is associated with the clinical diagnosis of pulmonary hypertension: results from a retrospective longitudinal study of a veteran population
COPD
Prevalence of pulmonary hypertension and its influence on survival in patients with advanced chronic obstructive pulmonary disease prior to lung transplantation
COPD
Cited by (22)
Reintubation After Lung Cancer Resection: Development and External Validation of a Predictive Score
2024, Annals of Thoracic SurgeryCitation Excerpt :Our findings support the greater importance of Dlco%. Although FEV1% is mostly a measure of small airway function, Dlco% is a surrogate variable for alveolar perfusion and structural lung alteration.24 The value of Dlco% as an outcome predictor is supported by observation in patients with chronic obstructive pulmonary disease, where Dlco% predicted adverse outcomes more reliably than FEV1%.25
Therapeutic potential and protective role of GRK6 overexpression in pulmonary arterial hypertension
2023, Vascular PharmacologyHemodynamic characteristics in patients with pulmonary hypertension and chronic obstructive pulmonary disease: A retrospective monocentric cohort study
2023, Respiratory Medicine and ResearchSevere Pulmonary Hypertension in COPD: Impact on Survival and Diagnostic Approach
2022, ChestCitation Excerpt :Multivariate analysis, however, identified only two independent predictors: 6-min walk distance, with a best predictive threshold at 200 m, and systemic pulmonary vascular resistance index, with the best predictive threshold at 2,800 dyn/s/cm5/m2. Of note, in this analysis, only patients with severe PH were included, which may explain why some previously described prognostic parameters for COPD or for group 3 PH, such as lung diffusion capacity for carbon monoxide19,20 or pulmonary artery enlargement,18,21-23 did not reach statistical significance. The fact that the absence of a high systemic pulmonary vascular resistance index was an independent predictor of poor prognosis in the multivariate analysis suggests that systemic vasodilation (eg, resulting from hypoxemia) may represent an important complication in these patients, which deserves further exploration.
FUNDING/SUPPORT: This work was supported by the National Heart Lung and Blood Institute [grant T32 HL007534-36].