Severe Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease - From Clinical Perspective to Histological Evidence

Overview

Journal Int J Cardiol Congenit Heart Dis

Date 2024 Dec 23

PMID 39711774

Authors

Katarina Zeder

Teresa Sassmann

Vasile Foris

Philipp Douschan

Horst Olschewski

Gabor Kovacs

Affiliations

Soon will be listed here.

Abstract

Severe pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) is currently defined by an elevated mean pulmonary arterial pressure and strongly elevated pulmonary vascular resistance >5 wood units. Clinically, these patients show a male predominance, and usually present with very severe dyspnea, severe hypoxemia, strongly decreased exercise capacity and poor prognosis, even though the clinical picture is frequently associated with less severe airflow obstruction. Explanted lung samples of patients with COPD and severe PH show severe remodeling of small pulmonary arterioles, predominantly in the intima and media of the vessels. In this concise review, we discuss the clinical and histopathological evidence of severe PH in COPD.

References

Olsson K, Hoeper M, Pausch C, Grunig E, Huscher D, Pittrow D . Pulmonary vascular resistance predicts mortality in patients with pulmonary hypertension associated with interstitial lung disease: results from the COMPERA registry. Eur Respir J. 2021; 58(2). DOI: 10.1183/13993003.01483-2021. View

Sassmann T, Douschan P, Foris V, Troster N, Zeder K, Brcic L . Abnormal pulmonary hemodynamics during exercise is associated with exercise capacity in COPD. Respir Res. 2022; 23(1):331. PMC: 9733173. DOI: 10.1186/s12931-022-02238-9. View

Nathan S, Barbera J, Gaine S, Harari S, Martinez F, Olschewski H . Pulmonary hypertension in chronic lung disease and hypoxia. Eur Respir J. 2018; 53(1). PMC: 6351338. DOI: 10.1183/13993003.01914-2018. View

Greiner S, Jud A, Aurich M, Hess A, Hilbel T, Hardt S . Reliability of noninvasive assessment of systolic pulmonary artery pressure by Doppler echocardiography compared to right heart catheterization: analysis in a large patient population. J Am Heart Assoc. 2014; 3(4). PMC: 4310406. DOI: 10.1161/JAHA.114.001103. View

Wells J, Washko G, Han M, Abbas N, Nath H, Mamary A . Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med. 2012; 367(10):913-21. PMC: 3690810. DOI: 10.1056/NEJMoa1203830. View

Olschewski H . The Challenge to Decide between Pulmonary Hypertension Due to Chronic Lung Disease and PAH with Chronic Lung Disease. Diagnostics (Basel). 2021; 11(2). PMC: 7918977. DOI: 10.3390/diagnostics11020311. View

Maron B, Brittain E, Hess E, Waldo S, Baron A, Huang S . Pulmonary vascular resistance and clinical outcomes in patients with pulmonary hypertension: a retrospective cohort study. Lancet Respir Med. 2020; 8(9):873-884. PMC: 8219057. DOI: 10.1016/S2213-2600(20)30317-9. View

van der Bruggen C, Nossent E, Grunberg K, Bogaard H, Vonk Noordegraaf A . The Real Face of Borderline Pulmonary Hypertension in Connective Tissue Disease. Ann Am Thorac Soc. 2016; 13(8):1428-30. DOI: 10.1513/AnnalsATS.201604-275LE. View

Humbert M, Kovacs G, Hoeper M, Badagliacca R, Berger R, Brida M . 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2022; 61(1). DOI: 10.1183/13993003.00879-2022. View

10.

Galie N, Humbert M, Vachiery J, Gibbs S, Lang I, Torbicki A . 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS):.... Eur Respir J. 2015; 46(4):903-75. DOI: 10.1183/13993003.01032-2015. View

11.

Hoeper M, Pausch C, Grunig E, Klose H, Staehler G, Huscher D . Idiopathic pulmonary arterial hypertension phenotypes determined by cluster analysis from the COMPERA registry. J Heart Lung Transplant. 2020; 39(12):1435-1444. DOI: 10.1016/j.healun.2020.09.011. View

12.

Hoeper M, Dwivedi K, Pausch C, Lewis R, Olsson K, Huscher D . Phenotyping of idiopathic pulmonary arterial hypertension: a registry analysis. Lancet Respir Med. 2022; 10(10):937-948. PMC: 9514996. DOI: 10.1016/S2213-2600(22)00097-2. View

13.

Hoeper M, Humbert M, Souza R, Idrees M, Kawut S, Sliwa-Hahnle K . A global view of pulmonary hypertension. Lancet Respir Med. 2016; 4(4):306-22. DOI: 10.1016/S2213-2600(15)00543-3. View

14.

Awerbach J, Stackhouse K, Lee J, Dahhan T, Parikh K, Krasuski R . Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance. Respir Med. 2019; 150:126-130. DOI: 10.1016/j.rmed.2019.03.004. View

15.

Carlsen J, Andersen K, Boesgaard S, Iversen M, Steinbruchel D, Andersen C . Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease. J Heart Lung Transplant. 2012; 32(3):347-54. DOI: 10.1016/j.healun.2012.11.014. View

16.

Ferrer E, Peinado V, Diez M, Carrasco J, Musri M, Martinez A . Effects of cigarette smoke on endothelial function of pulmonary arteries in the guinea pig. Respir Res. 2009; 10:76. PMC: 3224554. DOI: 10.1186/1465-9921-10-76. View

17.

Seeger W, Adir Y, Barbera J, Champion H, Coghlan J, Cottin V . Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013; 62(25 Suppl):D109-16. DOI: 10.1016/j.jacc.2013.10.036. View

18.

Santos S, Peinado V, Ramirez J, Melgosa T, Roca J, Rodriguez-Roisin R . Characterization of pulmonary vascular remodelling in smokers and patients with mild COPD. Eur Respir J. 2002; 19(4):632-8. DOI: 10.1183/09031936.02.00245902. View

19.

Gredic M, Wu C, Hadzic S, Pak O, Savai R, Kojonazarov B . Myeloid-cell-specific deletion of inducible nitric oxide synthase protects against smoke-induced pulmonary hypertension in mice. Eur Respir J. 2021; 59(4). PMC: 8989054. DOI: 10.1183/13993003.01153-2021. View

20.

Seimetz M, Parajuli N, Pichl A, Veit F, Kwapiszewska G, Weisel F . Inducible NOS inhibition reverses tobacco-smoke-induced emphysema and pulmonary hypertension in mice. Cell. 2011; 147(2):293-305. DOI: 10.1016/j.cell.2011.08.035. View