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1 Clinical Pharmacology and 2 Clinical Cardiology, Imperial College School of Medicine
CORRESPONDENCE: N.W. Morrell, Section on Clinical Pharmacology, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK. Fax: +44 208 743 9733
Keywords: chronic obstructive pulmonary disease, doppler echocardiography, secondary pulmonary hypertension
Received: August 8, 2000
Accepted September 25, 2000
This study was funded in part by a grant-in-aid from Merck Sharp & Dohme Ltd.
Studies have confirmed the close correlation of echocardiographically estimated pulmonary arterial pressure with invasive measurements in patients with chronic obstructive pulmonary disease (COPD), but there are few data on utility of echocardiographic measurement in assessing pulmonary arterial hypertension (PH) in COPD and correlation with pulmonary function tests.
Presence or absence of tricuspid regurgitation (TR) was determined by Doppler echocardiography in 73 consecutive COPD patients attending a hospital outpatient clinic. Transtricuspid pressure gradient (TTPG) was calculated. PH was defined as TTPG
Measurable TR was observed in 56/73 patients (77%). There were no differences between the group in which TR was observed compared to that in which it was absent, with regard to age, smoking history nor pulmonary function variables. PH was seen in 31/56 cases (55%), with good reproducibility. There were statistically significant correlations of TTPG with FEV1 (r=–0.26, p=0.05), KCO (r=–0.31, p=0.04) and DL,CO (r=–0.42, p=0.006) expressed as % pred. Stepwise regression analysis showed that age and KCO combined provide a multivariate model for prediction of TTPG.
It is concluded the presence and degree of pulmonary arterial hypertension is readily and reliably determined by echocardiography in the majority of chronic obstructive pulmonary disease patients. Pulmonary arterial hypertension is common in severe chronic obstructive pulmonary disease and transtricuspid pressure gradient correlates with spirometry and indices of gas transfer, similar to previous invasive studies. In view of the adverse effects of pulmonary arterial hypertension on morbidity and mortality routine echocardiography in patients with severe chronic obstructive pulmonary disease may be warranted.
30 mmHg. Patients also underwent spirometry, forced expiratory volume in one second (FEV1), single breath gas transfer (carbon monoxide transfer coefficient; (KCO) and carbon monoxide diffusing capacity of the lung; DL,CO) and arterial blood gas measurement.
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