Prevalence and Prognostic Value of Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease

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Introduction Pulmonary hypertension (PH) significantly influences chronic obstructive pulmonary disease (COPD) outcomes by exacerbating symptoms, increasing the frequency and severity of exacerbations, and contributing to higher hospitalization rates and mortality. Ultrasound assessment of mean pulmonary arterial pressure (PAPm) may contribute to the severity assessment of COPD. This study aims to assess the one-year prognostic value of PAPm at rest and after exercise in COPD patients. Methods This was an observational, prospective study of stable COPD patients over 40 years of age who were current or former smokers with a smoking history of >10 pack-years and a postbronchodilator FEV1 (forced expiratory volume in 1 second)/FVC (forced vital capacity) <0.7. Exclusion criteria were other significant lung diseases, systemic inflammatory diseases, or non-compliance with study procedures. PAPm was calculated using peak tricuspid regurgitation velocity via transthoracic echocardiography at rest and after a 6-minute walking test (6MWT) as a predictor of COPD exacerbations and death in one year. Patients were followed for 12 months to assess COPD exacerbations and mortality outcomes. Results A total of 96 patients were analyzed with a mean FEV1 (% predicted) of 55.8%. The prevalence of PH in this group was 52.1% (50/96). PAPm at rest was a stronger predictor of exacerbations, with an area under the curve (AUC) of 0.732, compared to PAPm after exercise (AUC: 0.700). The patients with PH had a significantly higher number of exacerbations (1.65 vs 0.89, p = 0.002). The patients with PAPm ≥30 after exercise also have a considerably higher number of exacerbations (1.64 vs. 1.1, p = 0.026). In univariate analysis, age, pack-years, FEV1, FVC, 6-minute walk distance (6MWD), COPD Assessment Test (CAT) score, previous exacerbations, PAPm, and PAPm after exertion are significant predictors for exacerbations and/or composite outcome (exacerbation or death). In multivariate analysis, however, only previous exacerbations remain significant in all models. Conclusion This study found a 52.1% prevalence of PH. Patients with PH at rest and after exercise had more frequent exacerbations during follow-up. Integrating non-invasive PAPm measurement into routine clinical practice could enhance risk stratification, guide treatment strategies, and improve patient outcomes.

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