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Torres-Castro R, Gimeno-Santos E, Vilaró J, Roqué-Figuls M, Moisés J, Vasconcello-Castillo L, Orizaga T, Barberà JA, Blanco I. Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis. Eur Respir Rev 2021; 30:30/160/200321. [PMID: 33927006 PMCID: PMC9489125 DOI: 10.1183/16000617.0321-2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Pulmonary hypertension (PH) is a frequent complication in patients with COPD. Objective To determine if, in patients with COPD, the presence of PH decreases exercise tolerance. Methods We included studies that analysed exercise tolerance using a cardiopulmonary exercise test (CPET) in patients with COPD with PH (COPD-PH) and without PH (COPD-nonPH). Two independent reviewers analysed the studies, extracted the data and assessed the quality of the evidence. Results Of the 4915 articles initially identified, seven reported 257 patients with COPD-PH and 404 patients with COPD-nonPH. The COPD-PH group showed differences in peak oxygen consumption (V′O2peak), −3.09 mL·kg−1·min−1 (95% CI −4.74 to −1.43, p=0.0003); maximum workload (Wmax), −20.5 W (95% CI −34.4 to −6.5, p=0.004); and oxygen pulse (O2 pulse), −1.24 mL·beat−1 (95% CI −2.40 to −0.09, p=0.03), in comparison to the group with COPD-nonPH. If we excluded studies with lung transplant candidates, the sensitivity analyses showed even bigger differences: V′O2, −4.26 mL·min−1·kg−1 (95% CI −5.50 to −3.02 mL·kg−1·min−1, p<0.00001); Wmax, −26.6 W (95% CI −32.1 to −21.1 W, p<0.00001); and O2 pulse, −2.04 mL·beat−1 (95% CI −2.92 to −1.15 mL·beat−1, p<0.0001). Conclusion Exercise tolerance was significantly lower in patients with COPD-PH than in patients with COPD-nonPH, particularly in nontransplant candidates. The V′O2peak, Wmax and O2 pulse values were significantly lower in patients with COPD-PH than in patients with COPD-nonPH, particularly in nontransplant candidateshttps://bit.ly/3s5dtJ9
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Affiliation(s)
- Rodrigo Torres-Castro
- Dept of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Dept of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Elena Gimeno-Santos
- Dept of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Jordi Vilaró
- Blanquerna School of Health Sciences, Global Research on Wellbeing (GRoW), Universitat Ramon Llull, Barcelona, Spain
| | - Marta Roqué-Figuls
- Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jorge Moisés
- Dept of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | | | - Tanya Orizaga
- Dept of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Joan Albert Barberà
- Dept of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain.,Contributed equally as senior authors
| | - Isabel Blanco
- Dept of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain .,Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain.,Contributed equally as senior authors
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Diagnostic Validity of Cardiopulmonary Exercise Testing for Screening Pulmonary Hypertension in Patients With Chronic Obstructive Pulmonary Disease. J Cardiopulm Rehabil Prev 2020; 40:189-194. [PMID: 31714394 DOI: 10.1097/hcr.0000000000000456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine diagnostic validity of cardiopulmonary exercise testing (CPX) parameters for detecting pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD) and to investigate association between CPX parameters and indices of PH. METHODS This cross-sectional study enrolled 48 moderate to very severe COPD patients in whom PH was confirmed by echocardiography. Symptom-limited CPX was performed using an incremental exercise protocol. Relevant CPX parameters were derived and were tested for their diagnostic ability for diagnosing PH. Logistic regression was applied to examine the effect of various clinical covariates on the diagnostic ability of exercise test variables for detecting PH. RESULTS Of the 48 patients, 29 were diagnosed with PH and 19 were negative for PH based on echocardiographic testing. CPX measures including peak oxygen uptake (% predicted (Equation is included in full-text article.)O2peak, (Equation is included in full-text article.)O2peak [mL/min], (Equation is included in full-text article.)O2/kg), oxygen pulse ((Equation is included in full-text article.)O2/HR % predicted, (Equation is included in full-text article.)O2/HR mL/beat), and peak minute ventilation ((Equation is included in full-text article.)Epeak [L/m]) were inversely correlated with mean pulmonary arterial pressure (mPAP). Peak (Equation is included in full-text article.)O2/HR and (Equation is included in full-text article.)O2peak were found to be significant predictors of PH in univariate analysis. (Equation is included in full-text article.)O2peak (%), (Equation is included in full-text article.)O2/HR (mL/beat), and desaturation (%) were identified as independent predictors of PH adjusted for age, forced expiratory volume in 1 sec (%), and forced vital capacity (L). CONCLUSION The present study validates the use of CPX parameters such as (Equation is included in full-text article.)O2peak and (Equation is included in full-text article.)O2/HR as a diagnostic tool for correctly identifying PH in COPD patients. Therefore, CPX may be used as an adjunct to echocardiographic measurement of PH where there is unavailability of equipment and expertise.
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Blanco I, Valeiro B, Torres-Castro R, Barberán-García A, Torralba Y, Moisés J, Sebastián L, Osorio J, Rios J, Gimeno-Santos E, Roca J, Barberà JA. Effects of Pulmonary Hypertension on Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease. Arch Bronconeumol 2019; 56:499-505. [PMID: 31771920 DOI: 10.1016/j.arbres.2019.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/17/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The impact of pulmonary hypertension (PH) on exercise tolerance in chronic obstructive pulmonary disease (COPD) has not been fully elucidated. It is necessary to characterize pulmonary hemodynamics in patients with moderate to severe COPD in order to improve their management. The aim of the study was to determine whether in COPD the presence of PH is associated with reduced exercise tolerance in a cohort of stable COPD patients. METHODS Cross-sectional analysis of 174 COPD patients clinically stable: 109 without PH and 65 with PH (COPD-PH). We assessed socio-demographic data, lung function, quality of life, dyspnea, cardiopulmonary exercise testing (CPET), constant workload endurance time (CWET), and six-minute walk test (6MWT). We elaborated a logistic regression model to explore the impact of PH on exercise capacity in COPD patients. RESULTS COPD-PH patients showed lower exercise capacity both at maximal (CPET) (43(20) versus 68(27) Watts and 50(19)% versus 71(18)% predicted peak oxygen consumption (VO2peak), COPD-PH and COPD, respectively), and at submaximal tests (6MWT) (382(94) versus 486(95) m). In addition, the COPD-PH group had lower endurance time than the non-PH COPD group (265(113) s and 295(164) s, respectively). CONCLUSIONS The presence of PH is an independent factor that impairs exercise capacity in COPD.
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Affiliation(s)
- Isabel Blanco
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
| | - Beatriz Valeiro
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rodrigo Torres-Castro
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Anael Barberán-García
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yolanda Torralba
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Jorge Moisés
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Laura Sebastián
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jeisson Osorio
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José Rios
- Medical Statistics core facility, IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Gimeno-Santos
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Roca
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Joan A Barberà
- Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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Skjørten I, Hilde JM, Melsom MN, Hisdal J, Hansteen V, Steine K, Humerfelt S. Cardiopulmonary exercise test and PaO 2 in evaluation of pulmonary hypertension in COPD. Int J Chron Obstruct Pulmon Dis 2017; 13:91-100. [PMID: 29339921 PMCID: PMC5744745 DOI: 10.2147/copd.s150034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Exercise tolerance decreases as COPD progresses. Pulmonary hypertension (PH) is common in COPD and may reduce performance further. COPD patients with and without PH could potentially be identified by cardiopulmonary exercise test (CPET). However, results from previous studies are diverging, and a unified conclusion is missing. We hypothesized that CPET combined with arterial blood gases is useful to discriminate between COPD outpatients with and without PH. Methods In total, 93 COPD patients were prospectively included. Pulmonary function tests, right heart catheterization, and CPET with blood gases were performed. The patients were divided, by mean pulmonary artery pressure, into COPD-noPH (<25 mmHg) and COPD-PH (≥25 mmHg) groups. Linear mixed models (LMMs) were fitted to estimate differences when repeated measurements during the course of exercise were considered and adjusted for gender, age, and airway obstruction. Results Ventilatory and/or hypoxemic limitation was the dominant cause of exercise termination. In LMM analyses, significant differences between COPD-noPH and COPD-PH were observed for PaO2, SaO2, PaCO2, ventilation, respiratory frequency, and heart rate. PaO2 <61 mmHg (8.1 kPa) during unloaded pedaling, the only load level achieved by all the patients, predicted PH with a sensitivity of 86% and a specificity of 78%. Conclusion During CPET, low exercise performance and PaO2 strongly indicated PH in COPD patients.
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Affiliation(s)
- Ingunn Skjørten
- Department of Pulmonary Medicine, LHL Glittre Clinic, Hakadal.,Faculty of Medicine, University of Oslo, Oslo
| | | | | | | | | | - Kjetil Steine
- Faculty of Medicine, University of Oslo, Oslo.,Department of Cardiology, Akershus University Hospital, Lørenskog
| | - Sjur Humerfelt
- Clinic of Allergology and Respiratory Medicine, Oslo, Norway
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Mohamed Hoesein FA, Besselink T, Pompe E, Oudijk EJ, de Graaf EA, Kwakkel-van Erp JM, de Jong PA, Luijk B. Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD. Lung 2016; 194:813-9. [PMID: 27423782 PMCID: PMC5031745 DOI: 10.1007/s00408-016-9926-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/11/2016] [Indexed: 11/18/2022]
Abstract
Introduction Pulmonary hypertension (PH) in COPD is associated with a higher mortality and an increased risk on exacerbations compared to COPD patients without PH. The aim was to evaluate the diagnostic value of pulmonary artery (PA) measurements on chest computed tomography (CT) for PH in end-stage COPD. Methods COPD patients evaluated for eligibility for lung transplantation between 2004 and 2015 were retrospectively analyzed. Clinical characteristics, chest CTs, spirometry, and right-sided heart catheterizations (RHC) were studied. Diameters of PA and ascending aorta (A) were measured on CT. Diagnostic properties of different cut-offs of PA diameter and PA:A ratio in diagnosing PH were calculated. Results Of 92 included COPD patients, 30 (32.6 %) had PH at RHC (meanPAP > 25 mm Hg). PA:A > 1 had a negative predictive value (NPV) of 77.9 % and a positive predictive value (PPV) of 63.1 % with an odds ratio (OR (CI 95 %)) of 5.60 (2.00–15.63). PA diameter ≥30 mm had a NPV of 78 % and PPV of 64 % with an OR (CI 95 %) of 6.95 (2.51–19.24). Conclusion A small PA diameter and PA:A make the presence of PH unlikely but cannot exclude its presence in end-stage COPD. A large PA diameter and PA:A maybe used to detect PH early.
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Affiliation(s)
- Firdaus A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands.
| | - Tim Besselink
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands
| | - Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands
| | - Erik-Jan Oudijk
- Department of Respiratory Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ed A de Graaf
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M Kwakkel-van Erp
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508, Utrecht, The Netherlands
| | - Bart Luijk
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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