Initial risk assessment for pulmonary hypertension in patients with COPD

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dc.contributor.author Yammine, Joe
dc.contributor.author Gartman, Eric J.
dc.contributor.author Blundin, Michael
dc.contributor.author Klinger, James R.
dc.contributor.author Roberts, Mary B.
dc.contributor.author McCool, Dennis
dc.date.accessioned 2019-04-16T12:01:45Z
dc.date.available 2019-04-16T12:01:45Z
dc.date.copyright 2012 en_US
dc.date.issued 2019-04-16
dc.identifier.issn 1432-1750 en_US
dc.identifier.uri http://hdl.handle.net/10725/10459
dc.description.abstract Background Pulmonary hypertension (PH) is a comorbidity associated with increased mortality in chronic obstructive pulmonary disease (COPD) patients. It is not known which clinical markers are predictive of PH in COPD. The goal of this study was to develop a clinical tool to identify patients who should be sent for initial screening with echocardiography. Methods Of 127 patients screened, 94 primary-care patients with COPD were enrolled. All underwent full pulmonary function testing, 6-minute walk distance (6MWD), exercise oximetry, Saint George’s Respiratory Questionnaire, and transthoracic echocardiography. Eighty-six patients had measurable pulmonary artery pressures (PAP) on echocardiography. Elevated PAP was defined as a systolic PAP > 35 mmHg. Results Pre- and post-bronchodilator FEV1 (P = 0.04 and P = 0.03, respectively), exercise oxyhemoglobin desaturation (P = 0.003), and 6MWD (P = 0.004) were associated with elevated PAP on univariate analysis. Diffusion capacity was lower but did not reach statistical significance (P = 0.07). In multivariate analysis, statistically significant independent variables were >3% decrease in exercise oxyhemoglobin saturation and decline in prebronchodilator FEV1 (P = 0.01 and P = 0.04, respectively). A composite prediction model was developed that assigned one point for each of the following: age > 55 years, oxyhemoglobin desaturation > 3%, prebronchodilator FEV1 < 50% predicted, and 6MWD < 1175 ft. Prevalence rates of elevated PAP were 32% for a score of 0–1 (low risk), 68% for a score of 2 (moderate risk), and 78% for a score of 3–4 (high risk). The composite score exhibited a strong trend with elevated PAP prevalence (Cochrane-Armitage trend statistic P = 0.001). Conclusion A simple prediction tool using routine office-based parameters can be used to identify COPD patients at high risk for elevated PAP and initiate the first step in screening for PH with echocardiography. It is important that right heart catheterization be performed to confirm the diagnosis and guide treatment decisions. en_US
dc.language.iso en en_US
dc.title Initial risk assessment for pulmonary hypertension in patients with COPD en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOM en_US
dc.author.idnumber 201004814 en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Lung en_US
dc.journal.volume 190 en_US
dc.journal.issue 1 en_US
dc.article.pages 83-89 en_US
dc.keywords Pulmonary hypertension en_US
dc.keywords COPD en_US
dc.keywords Risk assessment en_US
dc.identifier.ctation Gartman, E. J., Blundin, M., Klinger, J. R., Yammine, J., Roberts, M. B., & McCool, F. D. (2012). Initial risk assessment for pulmonary hypertension in patients with COPD. Lung, 190(1), 83-89. en_US
dc.author.email joseph.yammine@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url https://link.springer.com/article/10.1007/s00408-011-9346-8 en_US
dc.author.affiliation Lebanese American University en_US

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