Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation

Chest. 2005 May;127(5):1531-6. doi: 10.1378/chest.127.5.1531.


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: FEV(1), 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 Pao(2) 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 FEV(1), 48.5%) contrasting with high level of pulmonary artery pressure (PAPm, 39.8 mm Hg), and severe hypoxemia (mean Pao(2), 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.

MeSH terms

  • Adult
  • Cluster Analysis
  • Female
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / epidemiology
  • Hypertension, Pulmonary / physiopathology
  • Lung / physiopathology*
  • Lung Transplantation
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumonectomy
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Disease, Chronic Obstructive / surgery
  • Respiratory Function Tests
  • Retrospective Studies