Pulmonary hypertension in chronic obstructive pulmonary disease and emphysema patients: prevalence, therapeutic options and pulmonary circulatory effects of lung volume reduction surgery

Journal of Thoracic Disease
Isabelle Opitz, Silvia Ulrich

Abstract

The exact prevalence of pulmonary hypertension (PH) and cor pulmonale (CP) in chronic obstructive pulmonary disease (COPD) is unknown, and varies considerably from 20-91%. Usually, mean pulmonary artery pressure (mPAP) does not exceed 30 mmHg, and PH is not severe. However, PH and CP are important predictors of mortality in COPD and contribute to disability in this disease. Many factors contribute to the development of PH in chronic lung disease, including reduction of the pulmonary vascular cross-sectional area due to parenchymal loss and accompanying hypoxia, effects of abnormal pulmonary mechanics due to hyperinflation, but also vascular remodeling processes. So far, PH associated with chronic lung disease cannot be treated medically. Therefore, it is indicated to treat the underlying pulmonary disease. Patients with severe PH should be referred to centers experienced in the management of PH and enrollment in clinical trials should be considered. Lung volume reduction surgery (LVRS) theoretically further increases pulmonary vascular resistance (PVR) by reducing the vascular bed when resecting lung tissue, however, this might be compensated by better pulmonary mechanics through reduction of hyperinflation, which will be discu...Continue Reading

Citations

Jul 14, 2020·Current Opinion in Pulmonary Medicine·Eileen M Harder, Aaron B Waxman
Jul 2, 2020·International Journal of Chronic Obstructive Pulmonary Disease·Isabel BlancoJoan Albert Barberà
Dec 1, 2020·Clinical and Translational Medicine·Sabrina Setembre BatahAlexandre Todorovic Fabro
Sep 30, 2020·The Annals of Thoracic Surgery·Martin E EichhornRalf Eberhardt
May 1, 2021·Thoracic Surgery Clinics·Daniel P McCarthyMalcolm M DeCamp
Apr 30, 2021·Frontiers in Cardiovascular Medicine·Srikanth KarnatiSüleyman Ergün
Oct 15, 2019·The Annals of Thoracic Surgery·Sowmyanarayanan ThuppalStephen Hazelrigg

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