PMID- 22094960
OWN - NLM
STAT- MEDLINE
DCOM- 20120726
LR  - 20211021
IS  - 1432-1750 (Electronic)
IS  - 0341-2040 (Linking)
VI  - 190
IP  - 1
DP  - 2012 Feb
TI  - Initial risk assessment for pulmonary hypertension in patients with COPD.
PG  - 83-9
LID - 10.1007/s00408-011-9346-8 [doi]
AB  - 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 FEV(1) (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 FEV(1) (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 FEV(1) < 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.
FAU - Gartman, Eric J
AU  - Gartman EJ
AD  - Division of Pulmonary, Memorial Hospital of Rhode Island, Alpert Medical School 
      of Brown University, 111 Brewster Street, Pawtucket, RI 02860, USA. 
      eric_gartman@brown.edu
FAU - Blundin, Michael
AU  - Blundin M
FAU - Klinger, James R
AU  - Klinger JR
FAU - Yammine, Joe
AU  - Yammine J
FAU - Roberts, Mary B
AU  - Roberts MB
FAU - Dennis McCool, F
AU  - Dennis McCool F
LA  - eng
PT  - Journal Article
DEP - 20111118
PL  - United States
TA  - Lung
JT  - Lung
JID - 7701875
RN  - 0 (Oxyhemoglobins)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Echocardiography
MH  - Exercise Test
MH  - Female
MH  - Forced Expiratory Volume
MH  - Humans
MH  - Hypertension, Pulmonary/*complications/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Oximetry
MH  - Oxyhemoglobins/metabolism
MH  - Predictive Value of Tests
MH  - Pulmonary Disease, Chronic Obstructive/*complications/physiopathology
MH  - Risk Assessment
MH  - Surveys and Questionnaires
EDAT- 2011/11/19 06:00
MHDA- 2012/07/27 06:00
CRDT- 2011/11/19 06:00
PHST- 2011/08/05 00:00 [received]
PHST- 2011/11/04 00:00 [accepted]
PHST- 2011/11/19 06:00 [entrez]
PHST- 2011/11/19 06:00 [pubmed]
PHST- 2012/07/27 06:00 [medline]
AID - 10.1007/s00408-011-9346-8 [doi]
PST - ppublish
SO  - Lung. 2012 Feb;190(1):83-9. doi: 10.1007/s00408-011-9346-8. Epub 2011 Nov 18.