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Pulmonary Hemodynamics in Advanced COPD Candidates for Lung Volume Reduction Surgery or Lung Transplantation^*

^* From the Service de Pneumologie et Réanimation Respiratoire (Drs. Thabut, Dauriat, Stern, Marrash-Chahla, and Mal), and Service de Cardiologie (Dr. Logeart), Hôpital Beaujon, Clichy; and Service de Pneumologie (Dr. Lévy), Centre Hospitalier de Bourges, Bourges, France.

Correspondence to: Hervé Mal, MD, Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 B^d du Général Leclerc 92110, Clichy, France; e-mail: herve.mal{at}bjn.ap-hop-paris.fr

Study objectives: To assess the pulmonary hemodynamic characteristics in COPD candidates for lung volume reduction surgery (LVRS) or lung transplantation (LT).

Design: Retrospective study.

Setting: One center in France.

Patients: Two hundred fifteen patients with severe COPD who underwent right-heart catheterization before LVRS or LT.

Results: Mean age was 54.6 years. Pulmonary function test results were as follows: FEV₁, 24.3% predicted; total lung capacity, 128.3% predicted; residual volume, 259.7% predicted. Mean pulmonary artery pressure (PAPm) was 26.9 mm Hg. Pulmonary hypertension (PAPm > 25 mm Hg) was present in 50.2% and was moderate (PAPm, 35 to 45 mm Hg) or severe (PAPm > 45 mm Hg) in 9.8% and in 3.7% of patients, respectively. Cardiac index was low normal. PAPm was related to PaO₂ and alveolar-arterial oxygen gradient in multivariate analysis. Cluster analysis identified a subgroup of atypical patients (n = 16, 7.4%) characterized by moderate impairment of the pulmonary mechanics (mean FEV₁, 48.5%) contrasting with high level of pulmonary artery pressure (PAPm, 39.8 mm Hg), and severe hypoxemia (mean PaO₂, 46.2 mm Hg).

Conclusion: While pulmonary hypertension is observed in half of the COPD patients with advanced disease, moderate-to-severe pulmonary hypertension is not a rare event in these patients. We individualized a subgroup of patients presenting with a predominant vascular disease that could potentially benefit from vasodilators.

Key Words: COPD • hemodynamics • pulmonary hypertension

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