ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Clinical Insights into Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease
Session Title
TP121 - TP121 COPD: FROM CELLS TO THE CLINIC
Abstract
A4567 - Clinical Insights into Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease
Author Block: D. P. Cook1, M. Xu2, J. Annis3, V. Martucci1, M. C. Aldrich1, A. Hemnes1, E. Brittain1; 1Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States, 2Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States, 3Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States.
Introduction: Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). Little is known about the prevalence and clinical profiles of patients with COPD-PH. We report the clinical characteristics, hemodynamic profiles, and prognosis in a large population of patients with COPD referred for right heart catheterization (RHC).
Methods: We extracted data from all subjects referred for RHC between 1997-2017 in Vanderbilt’s de-identified medical record. PH was defined as mPAP >20mmHg. Pre- and post-capillary PH were defined according to contemporary guidelines. COPD was identified using a rules-based algorithm requiring the presence of 3 or greater ICD codes relevant to COPD. Patients without sufficient ICD coding data to ascertain COPD status were excluded. COPD severity was defined by pulmonary function testing in a subset with available data. Differences between COPD and COPD-PH were assessed using the Mann-Whitney U or Chi-square test.
Results: In total, we identified 6065 patients referred for RHC, of whom 1,509 (24.9%) had COPD and 1,213 had COPD and PH (80.4% of those with COPD). Among those with COPD and PH, 12.6% had pre-capillary PH, 33.6% had post-capillary PH, 21.5% had combined pre- and post-capillary PH, and 32.3% had PH with wedge pressure <15mmHg and pulmonary vascular resistance <3WU. Patients with COPD-PH had a higher prevalence of diabetes, atrial fibrillation, heart failure, and black race compared with COPD without PH. Individuals with COPD-PH had left sided remodeling (LV hypertrophy and left atrial enlargement) and lower stroke volume and PA oxygen saturation compared to COPD alone (p < 0.05 for all comparisons). Pulmonary function testing data from individuals with COPD-PH revealed subtype differences, with precapillary COPD-PH having lower DLCO values than the other COPD-PH subtypes. Lower FEV1 (β = 2.4, p = < 0.001) and DLCO (β = 2.3, p = < 0.001) was associated with higher mean PA pressure when adjusted for age, sex, and race. Patients with COPD-PH had significantly increased mortality compared with COPD alone (hazard ratio [HR]:1.70; 95% CI:1.28 to 2.26; p = 0.001) with the highest mortality among the combined pre- and post-capillary COPD-PH subgroup ([HR]: 2.39, 95% CI: 1.64-3.47; p = 0.001).
Conclusions: PH is common among patients with COPD referred for RHC. The etiology of PH in patients with COPD is often mixed due to multimorbidity and is associated with high mortality, which may have implications for risk factor management.
Author Block: D. P. Cook1, M. Xu2, J. Annis3, V. Martucci1, M. C. Aldrich1, A. Hemnes1, E. Brittain1; 1Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States, 2Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States, 3Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States.
Introduction: Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD). Little is known about the prevalence and clinical profiles of patients with COPD-PH. We report the clinical characteristics, hemodynamic profiles, and prognosis in a large population of patients with COPD referred for right heart catheterization (RHC).
Methods: We extracted data from all subjects referred for RHC between 1997-2017 in Vanderbilt’s de-identified medical record. PH was defined as mPAP >20mmHg. Pre- and post-capillary PH were defined according to contemporary guidelines. COPD was identified using a rules-based algorithm requiring the presence of 3 or greater ICD codes relevant to COPD. Patients without sufficient ICD coding data to ascertain COPD status were excluded. COPD severity was defined by pulmonary function testing in a subset with available data. Differences between COPD and COPD-PH were assessed using the Mann-Whitney U or Chi-square test.
Results: In total, we identified 6065 patients referred for RHC, of whom 1,509 (24.9%) had COPD and 1,213 had COPD and PH (80.4% of those with COPD). Among those with COPD and PH, 12.6% had pre-capillary PH, 33.6% had post-capillary PH, 21.5% had combined pre- and post-capillary PH, and 32.3% had PH with wedge pressure <15mmHg and pulmonary vascular resistance <3WU. Patients with COPD-PH had a higher prevalence of diabetes, atrial fibrillation, heart failure, and black race compared with COPD without PH. Individuals with COPD-PH had left sided remodeling (LV hypertrophy and left atrial enlargement) and lower stroke volume and PA oxygen saturation compared to COPD alone (p < 0.05 for all comparisons). Pulmonary function testing data from individuals with COPD-PH revealed subtype differences, with precapillary COPD-PH having lower DLCO values than the other COPD-PH subtypes. Lower FEV1 (β = 2.4, p = < 0.001) and DLCO (β = 2.3, p = < 0.001) was associated with higher mean PA pressure when adjusted for age, sex, and race. Patients with COPD-PH had significantly increased mortality compared with COPD alone (hazard ratio [HR]:1.70; 95% CI:1.28 to 2.26; p = 0.001) with the highest mortality among the combined pre- and post-capillary COPD-PH subgroup ([HR]: 2.39, 95% CI: 1.64-3.47; p = 0.001).
Conclusions: PH is common among patients with COPD referred for RHC. The etiology of PH in patients with COPD is often mixed due to multimorbidity and is associated with high mortality, which may have implications for risk factor management.
