Pulmonary hemodynamic profile in chronic obstructive pulmonary disease

Figures & data

Table 1 Anthropometric and functional characteristics of 139 patients grouped according to GOLD spirometric grades

	All	GOLD grade			ANOVA P-value
		2	3	4
N	139	46	56	37
Sex, M/F	134/5	46/0	53/3	35/2
Age (yr)	63±8	63±8	63±7	60±7	NS
BMI (m/kg2)	25±4	24±4	26±3	24±4	NS
FVC (% pred)	72±18	82±14	71±17*	60±17*,≠	<0.001
FEV1 (L)	1.3±0.6	1.9±0.5	1.2±0.2*	0.7±0.2*,≠	<0.001
FEV1 (% pred)	41±16	59±7	39±6*	20±4*,≠	<0.001
FEV1/FVC (%)	40±15	52±8	41±14*	25±8*,≠	<0.001
TLC (% pred)	116±21	113±17	112±22	124±22≠	0.004
RV (% pred)	200±75	156±44	191±69*	266±68*,≠	<0.001
IC (% pred)	62±18	76±16	63±16*	47±12*,≠	<0.001
RV/TLC (%)	61±11	52±8	59±9*	71±8*,≠	<0.001
IC/TLC ratio	0.26±0.07	0.32±0.06	0.27±0.07*	0.18±0.05*,≠	<0.001
DLco (% pred)	57±25	72±23	59±21*	36±15*,≠	<0.001
PaO2 (mmHg)	69±12	77±10	68±11*	62±11*,≠	<0.001
PaCO2 (mmHg)	40±6	37±4	41±6*	45±7*,≠	<0.001
AaPO2 (mmHg)	32±10	30±11	32±9	34±10	NS

Notes: Data are presented as means ± standard deviation. Significant differences within each variable are indicated as:

* different from GOLD grade 2;

≠ different from GOLD grade 3.

Abbreviations: AaPO₂, alveolar–arterial oxygen partial pressure difference; ANOVA, analysis of variance; BMI, body mass index; DLco, diffusing capacity for carbon dioxide; FEV₁, post-bronchodilator forced expiratory volume in 1 second; FEV₁/FVC, post-bronchodilator forced expiratory volume in 1 second/post-bronchodilator forced vital capacity; FVC, post-bronchodilator forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; IC, inspiratory capacity; IC/TLC, inspiratory capacity/total lung capacity ratio; M/F, male/female; NS, not significant; PaCO₂, partial pressure of arterial carbon dioxide; PaO₂, partial pressure of arterial oxygen; pred, predicted; RV, residual volume; RV/TLC, residual volume/total lung capacity ratio; TLC, total lung capacity.

Table 2 Pulmonary hemodynamics at rest of 139 patients grouped according to the GOLD spirometric grades

	All	GOLD grade			ANOVA P-value
		2	3	4
N	139	46	56	37
mPAP (mmHg)	20±8	18±6	21±9	21±6	NS
PCWP (mmHg)	6±4	7±4	6±4	5±3	NS
RAP (mmHg)	2.9±3.2	3.4±3.5	2.1±3.2	2.7±2.7	NS
CO (L/min/m^2)	5.6±1.4	6.3±1.5	5.5±1.3*	4.7±0.8*,≠	<0.001
CI (L/min/m^2)	3.2±0.8	3.6±0.8	3.1±0.7*	2.8±0.6*,≠	<0.001
TPR (dyn⋅s⋅cm^−5)	306±158	244±105	322±197*	355±191*,≠	0.004
PVR (dyn⋅s⋅cm^−5)	218±143	160±88	233±185*	264±97*,≠	0.003
TPG	14±7	12±5	15±8	16±5*,≠	0.02
Patients with PH, n (%)	25 (18)	3 (7)	14 (25)	8 (22)

Notes: Data are presented as mean ± standard deviation. Significant differences within each variable are indicated as:

* different from GOLD grade 2;

≠ different from GOLD grade 3.

Abbreviations: ANOVA, analysis of variance; CI, cardiac index; CO, cardiac output; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; mPAP, mean pulmonary artery pressure; NS, not significant; PCWP, pulmonary capillary wedge pressure; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; RAP, right atrial pressure; TPG, transpulmonary pressure gradient; TPR, total pulmonary resistance.

Table 3 Subject characteristics in four COPD patients with severe pulmonary hypertension

Age (years)	FEV1 (% pred)	DLco (% pred)	PaO2 (mmHg)	PaCO2 (mmHg)	mPAP (mmHg)	PCWP (mmHg)	PVR (dyn⋅s⋅cm^−5)	CI (L/min/m^2)
58	35	34	44	46	35	4	594	2.75
65	51	24	50	35	43	6	566	2.69
58	46	22	50	38	38	2	1,080	1.79
61	39	21	46	44	61	11	941	2.38

Abbreviations: COPD, chronic obstructive pulmonary disease; CI, cardiac index; DLco, diffusing capacity for carbon dioxide; FEV₁, post-bronchodilator forced expiratory volume in 1 second; mPAP, mean pulmonary artery pressure; NS, not significant; PaO₂, partial pressure of arterial oxygen; PaCO₂, partial pressure of arterial carbon dioxide; PCWP, pulmonary capillary wedge pressure; pred, predicted; PVR, pulmonary vascular resistance.

Table 4 Pulmonary hemodynamics during submaximal exercise in patients grouped to the GOLD spirometric grades (n=85)

	All	GOLD grade			ANOVA P-value
		2	3	4
Hemodynamics during exercise, N	85	40	39	6
mPAP (mmHg)	42±14	38±11	45±15	52±7	0.019
PCWP (mmHg)	20±9	19±9	21±10	20±6	NS
CO (L/min/m^2)	11.8±2.8	12.2±2.8	11.7±2.8	9.5±2.2	NS
CI (L/min/m^2)	6.5±1.5	6.7±1.5	6.3±1.5	5.4±1.1	NS
TPR (dyn⋅s⋅cm^−5)	315±174	265±105	345±215	454±146*	0.014
PVR (dyn⋅s⋅cm^−5)	171±134	136±72	191±173	274±86	0.02
TPG (mmHg)	22±11	19±8	24±13	31±7*	0.02
ΔmPAP/ΔCO (mmHg/L/min)	4.8±3.7	4.1±2.2	5.4±4.8	6.4±2.7
Abnormal mPAPa, n (%)	29 (34)	8 (20)	17 (46)	4 (67)
ΔmPAP/ΔCO >3, n (%)	60 (71)	28 (70)	26 (67)	6 (100)

Notes: Data are presented as mean ± standard deviation.

a mPAP: <50 years, >30 mmHg; ≥50 years, >46 mmHg. According to Kovacs et al.²⁶ Significant differences within each variable are indicated as:

* different from GOLD grade 2.

Abbreviations: GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; Δ, change; ANOVA, analysis of variance; CI, cardiac index; CO, cardiac output; mPAP, mean pulmonary artery pressure; NS, not significant; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; TPG, transpulmonary pressure gradient; TPR, total pulmonary resistance.

Table 5 Arterial blood gas profile at rest and during exercise in 85 patients with or without pulmonary hypertension

	No PH (n=73)	PH (n=12)	P-value
PaO2 (mmHg)	76±8	65±14	0.020
PaO2 exercise (mmHg)	74±12	54±11	0.001
PaCO2 (mmHg)	38±4	44±6	0.006
PaCO2 exercise (mmHg)	41±8	47±6	0.004

Note: Data are presented as mean ± standard deviation.

Abbreviations: PaCO₂, partial pressure of arterial carbon dioxide; PaO₂, partial pressure of arterial oxygen; PH, pulmonary hypertension.

Figure 1 Changes from rest to peak exercise in the hemodynamic variables in 85 patients who underwent exercise testing, grouped according GOLD stage.

Note: P-value differences from rest to exercise (paired t-tests).

Abbreviations: CI, cardiac index; GOLD, Global Initiative for Chronic Obstructive Pulmonary Disease; mPAP, mean pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; NS, not significant.

Figure 2 Cardiac index during exercise in patients with and without pulmonary hypertension (n=85).

Note: P-value indicates comparison between PH and non-PH (Mann–Whitney U-test).
Abbreviations: CI, cardiac index; PH, pulmonary hypertension.

Table 6 Univariate and multivariate logistic regression analysis of variables associated with pulmonary hypertension

Independent variable	Univariate analysis		Multivariate analysis*
	OR (CI 95%)	P-value	OR (95% confidence interval)	P-value
PaO2 (mmHg)	0.92 (0.89–0.96)	<0.001	0.92 (0.88–0.97)	0.001
DLco (mmHg)	0.86 (0.78–0.94)	0.002
PaCO2 (mmHg)	1.07 (1.01–1.15)	0.025
IC (% predicted)	0.97 (0.94–0.99)	0.028
FEV1 (% predicted)	0.96 (0.93–0.99)	0.026

Note:

* From forward stepwise procedure.

Abbreviations: DLco, diffusing capacity for carbon dioxide; FEV₁, post-bronchodilator forced expiratory volume in 1 second; IC, inspiratory capacity; OR, odds ratio; PaCO₂, partial pressure of arterial carbon dioxide; PaO₂, partial pressure of arterial oxygen.

KovacsGBergholdAScheidlSOlschewskiHPulmonary arterial pressure during rest and exercise in healthy subjects: a systematic reviewEur Respir J200934488889419324955

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