Noninvasive Predictors of Severe Pulmonary Hypertension in COPD

In patients with chronic obstructive pulmonary disease (COPD), the combination of echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP), and pulmonary artery/ascending aorta diameter ratio (PA/Ao-ratio) can predict severe pulmonary hypertension (PH) with high sensitivity and specificity, according to a study published in CHEST.

Because it is largely unknown which clinical variables predict the presence of severe PH in COPD, it is currently difficult to determine which COPD patients should receive diagnostic right heart catheterization. Noninvasive diagnostic tools are needed, along with more information on how severity of airflow limitation and pulmonary vascular disease contribute to mortality.  

The current study sought to address these information deficits. Investigators in Graz, Austria, retrospectively analyzed 142 consecutive COPD patients with suspected PH undergoing in-depth clinical evaluation including right heart catheterization in their PH clinic between 2005 and 2018 to determine predictors of severe PH and to assess how and airflow limitation in and severe PH affected mortality.

The researchers found severe PH could be predicted by a model incorporating a combination of clinical variables (echocardiographic systolic pulmonary arterial pressure (PAP) ≥56 mmHg; NT-proBNP plasma levels ≥650 pg/ml; and a main PA/Ao-ratio in chest computed tomography (CT) ≥0.93).The model predicted severe PH with high positive and negative predictive values (both 94%). They also found that both airflow limitation (P =.002) and PH severity (P =.012) remained independently associated with survival after correcting for age and gender and that the combination of airflow-limitation and severe PH had the poorest survival (P =.001).

The researchers concluded, “The severity of both airflow limitation and pulmonary vascular disease may similarly and independently contribute to impaired survival in patients with COPD.” They suggested that further studies are needed to validate these findings.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Kovacs G, Avian A, Bachmaier G, et al. Severe pulmonary hypertension in COPD – impact on survival and diagnostic approach. CHEST. Published online January 2, 2022. doi: 10.1016/j.chest.2022.01.031