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Long-term Effect of Vasodilator Therapy in Pulmonary Hypertension due to COPD: A Retrospective Analysis

Fossati, Laura ; Müller-Mottet, Séverine ; Hasler, Elisabeth ; Speich, Rudolf ; Bloch, Konrad ; Huber, Lars ; Ulrich Somaini, Silvia

In: Lung, 2014, vol. 192, no. 6, p. 987-995

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    Titre
    • Long-term Effect of Vasodilator Therapy in Pulmonary Hypertension due to COPD: A Retrospective Analysis
    Auteur
    • Fossati, Laura. Head of Pulmonary Hypertension Unit, Clinic for Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Müller-Mottet, Séverine. Head of Pulmonary Hypertension Unit, Clinic for Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Hasler, Elisabeth. Head of Pulmonary Hypertension Unit, Clinic for Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Speich, Rudolf. Head of Pulmonary Hypertension Unit, Clinic for Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Bloch, Konrad. Head of Pulmonary Hypertension Unit, Clinic for Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Huber, Lars. Head of Pulmonary Hypertension Unit, Clinic for Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Ulrich Somaini, Silvia. Head of Pulmonary Hypertension Unit, Clinic for Pulmonology, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Lung, 2014, vol. 192, no. 6, p. 987-995. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:325838
    Summary
    Purpose: Pulmonary hypertension (PH) due to COPD has dismal prognosis. We reviewed the long-term effect of PH-target therapy in severe PH-COPD. Method: Patients attending our PH-clinic were reviewed for PH-COPD receiving PH-target therapy. Baseline characteristics, death/transplantation until 2014, therapy, NYHA functional class, 6min walk distance (6MWD) and oxygen saturation (SpO2) at baseline, 3, 6, 12 and 24months were analysed. Results: Of 48 PH-COPD identified 21 were excluded (insufficient data, comorbidity). 27 patients (7 females, 21 smokers, 23 emphysema) with median (quartiles) baseline age 70 (60; 76)years, FEV1 60 (46; 78)%, FEV1/FVC 57 (51; 64)%, DLCO 42 (36; 59)%, mean pulmonary artery pressure 39 (32;44) mmHg under inhaled iloprost (10), subcutaneous prostanoids (2), intravenous prostanoids (3), endothelin receptor antagonists (15) and phosphodiesterase-5-inhibitors (25) were included. Under therapy, NYHA functional class improved from 3.5 (3; 4) to 3 (2; 4) after 3months and 3 (2; 3.5) after 6months (p=.02 and .008). The 6MWD improved from 373 (236; 452) to 395 (339; 472), 414 (285; 492) and 396 (308; 497)m at 3, 6 and 12months (p=.005, .006 and .011) with unchanged resting-SpO2 but decreased peak-exercise SpO2. During median follow-up of 5.9 (2.3; 8.4) years, 10 died, 2 were transplanted and 2 were lost to follow-up. Transplant-free survival at 1,2,3years was 92,69,54% and was similar for GOLD stages 1-4, but worse for patients with mPAP ≥40mmHg (p=.026), 6MWD <370m (p=0.008), resting SpO2 <92% (p=0.02) and peak-walk SpO2 <87% (p=0.012). Conclusion: PH-target vasodilator therapy improved NYHA functional class and 6MWD up to one year in highly selected patients with severe PH-COPD. Poor exercise capacity, low SpO2 and high mean pulmonary artery pressure at baseline but not airflow obstruction were associated with unfavourable outcome.