Bhattacharyya P, Sengupta S, Ray S, Mukherjee B, Aniruddha D and Saha D
Background: COPD with Pulmonary hypertension (COPD-PH) affects health status and survival adversely; Yet, PH-specific pharmacotherapy has not been recommended for lack of evidence. Recently, post-exercise maximum desaturation (‘desat-máx’) of ≥ 3% has been considered successfully to identify the responders for PH-specific therapy. It is important to validate the observation hemodynamically.
Method: The ‘ desat-máx ’ in 2-chair test was looked for in a cohort of clinico-radio-echocardiographically suggested COPD-PH patients. Their hemodynamic status was elaborated with Right Heart Catheterization (RHC) and those with high (>3%) desat-max were compared to those with low (<3%) desat-max.
Results: Out of 36 patients screened, a total of 15 patients of COPD-PH (all male ex-smokers having mean FEV1 (predicted percentage) as 37.61 ± 15.30) were included. Nine had a ‘desat-max’ ≥ 3% (mean-6.8 ± 2.6) while 6 had <3% (-1.81 ± 1.3). The higher de-saturators had lower FEV1 percentage (33.11 ± 16.88 vs. 44.16 ± 10.64; P=0.17) but had similar systolic pulmonary artery pressure (PAP) (53.2 ± 7.15 vs. 51.83 ± 4.87; p=0.33) and universally present left ventricular diastolic dysfunction (LVDD) in echocardiography. At RHC, the higher desaturators had higher mean-PAP (36.22 ± 7.87 vs. 25.5 ± 1.5; p=0.04), pulmonary wedge pressure (22.11 ± 7.06 vs. 18.83 ± 3.18; p=0.3), Pulmonary vascular resistance (4.0 ± 2.40 vs. 1.72 ± 0.5; p=0.04), transpulmonary gradient (14.11 ± 7.18 vs. 6.67 ± 2.42; p=0.03) with slightly lower cardiac output ((3.81 ± 1.22 vs. 4.18 ± 1.09; p=0.56).
Conclusion: The higher de-saturators (≥ 3%) in 2CT appear hemodynamically distinct with presence of significantly elevated precapillary PAP to be addressed by PH specific therapy. The issue of presence of concomitant class II PH in them needs further investigation.
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