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Original Research: COPD |

Impact of Pulmonary Artery Pressure on Exercise Function in Severe COPD

Michael W. Sims, MD, MSCE; David J. Margolis, MD, PhD; A. Russell Localio, JD, MPH, PhD; Reynold A. Panettieri, MD; Steven M. Kawut, MD, MS, FCCP; Jason D. Christie, MD, MSCE
Author and Funding Information

From the Pulmonary, Allergy, and Critical Care Division (Drs. Sims, Panettieri, Kawut, and Christie), Airways Biology Initiative, Department of Medicine, and the Center for Clinical Epidemiology and Biostatistics (Drs. Sims, Margolis, Localio, Kawut, and Christie), Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA.

Michael W. Sims, MD, MSCE, University of Pennsylvania, Department of Pulmonary, Allergy, and Critical Care, 423 Mutch Building, PPMC, 51 North 39th St, Philadelphia, PA 19104; e-mail: michael.sims@uphs.upenn.edu


This work was supported by National Institutes of Health grants T32-HL-007891, K30-HL-04134, HL082895, and HL086719.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):412-419. doi:10.1378/chest.08-2739
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Background:  Although pulmonary hypertension commonly complicates COPD, the functional consequences of increased pulmonary artery pressures in patients with this condition remain poorly defined.

Methods:  We conducted a cross-sectional analysis of a cohort of 362 patients with severe COPD who were evaluated for lung transplantation. Patients with pulmonary hemodynamics measured by cardiac catheterization and available 6-min walk test results were included. The association of mean pulmonary artery pressure (mPAP) with pulmonary function, echocardiographic variables, and 6-min walk distance was assessed.

Results:  The prevalence of pulmonary hypertension (mPAP, > 25 mm Hg; pulmonary artery occlusion pressure [PAOP], < 16 mm Hg) was 23% (95% confidence interval, 19 to 27%). In bivariate analysis, higher mPAP was associated with lower FVC and FEV1, higher Pco2 and lower Po2 in arterial blood, and more right heart dysfunction. Multivariate analysis demonstrated that higher mPAP was associated with shorter distance walked in 6 min, even after adjustment for age, gender, race, height, weight, FEV1, and PAOP (−11 m for every 5 mm Hg rise in mPAP; 95% confidence interval, −21 to −0.7; p = 0.04).

Conclusions:  Higher pulmonary artery pressures are associated with reduced exercise function in patients with severe COPD, even after controlling for demographics, anthropomorphics, severity of airflow obstruction, and PAOP. Whether treatments aimed at lowering pulmonary artery pressures may improve clinical outcomes in COPD, however, remains unknown.

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