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(COPD) is a common cause of pre-capillary pulmonary hypertension (PH). Pulmonary hypertension (PHT) is a common complication of COPD and is determinant for the prognosis of COPD.
PHT is defined as A mean PAP of ≥ 25 mmHg measured by right heart catheterization at rest.
Exercise tolerance in patients with COPD is reduced due to ventilatory limitation, gas exchange abnormalities, and deconditioning as the disease progresses, and this may impair functional capacity and the quality of life.
COPD patients usually terminate physical activity when the ventilatory requirement exceeds their maximal ventilatory capacity.
If they have PH, the altered hemodynamic response may reduce their exercise capacity further.
Nowadays, despite the fact that LTOT improves the survival of hypoxaemic patients, PH is still associated with lower survival rates . Importantly, an elevated Ppa was also associated with an increased risk of severe acute exacerbation in COPD patients with moderate-to-severe airflow limitation .
Impaired exercise tolerance in COPD patients would suggest that cardiopulmonary exercise test (CPET) is a valuable tool to reveal whether they have PH or not.
Transthoracic echocardiography (TTE) is one such tool and is widely available and safe. In addition to its role in diagnosis, it can be used to screen for high-risk patient populations, to assess prognosis and to monitor disease stability and response to treatment.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cardiopulmonary exercise test | Diagnostic Test | we prepared incremental treadmill exercise protocol in which the work rate increased at one-minute intervals.Transthoracic Echocardiography(TTE) : The first step non-invasive method to diagnose PHT. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Measurement of oxygen uptake during cardiopulmonary exercise testing (% predicted) | For the assessment whether the existence of pulmonary hypertension in COPD is related to characteristic findings during cardiopulmonary exercise testing (CPET). | Baseline |
| Measurement the arterial pO2 in mmHg and arterial pCO2 at baseline | The blood gases pO2 and pCO2 are taken to characterize the gas exchange during cardiopulmonary exercise which is a routine procedure | Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| measurement of symptoms quantified by COPD Assessment Test (CAT Assessment)- total score 40. | For the assessment of the symptoms of the study group and its relation to exercise capacity and the impact COPD on wellbeing and daily life - CAT score < 10 is associated with better outcome and prognosis but score = or > 10 is associated with poor outcome and prognosis. | Baseline |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with stable chronic obstructive pulmonary disease
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Amira Emad El-din | Contact | +201019937498 | tota_eg1993@yahoo.com | |
| Waleed Gamal Elddin | Contact | waleedGamalddin@yahoo.com |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29339921 | Background | Skjorten I, Hilde JM, Melsom MN, Hisdal J, Hansteen V, Steine K, Humerfelt S. Cardiopulmonary exercise test and PaO2 in evaluation of pulmonary hypertension in COPD. Int J Chron Obstruct Pulmon Dis. 2017 Dec 22;13:91-100. doi: 10.2147/COPD.S150034. eCollection 2018. | |
| 7651072 | Background | Sarac R, Cikes I, Butkovic D, Dimov-Butkovic D. [Doppler echocardiography in the evaluation of pulmonary hypertension in chronic obstructive pulmonary disease]. Lijec Vjesn. 1995 Jan-Feb;117(1-2):9-15. Croatian. |
| Label | URL |
|---|---|
| Holverda S et al. Respiration. (2008) | View source |
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| ID | Term |
|---|---|
| D029424 | Pulmonary Disease, Chronic Obstructive |
| ID | Term |
|---|---|
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002908 | Chronic Disease |
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| ID | Term |
|---|---|
| D005080 | Exercise Test |
| D004452 | Echocardiography |
| D012129 | Respiratory Function Tests |
| D001784 | Blood Gas Analysis |
| D004562 | Electrocardiography |
| ID | Term |
|---|---|
| D006334 | Heart Function Tests |
| D003935 | Diagnostic Techniques, Cardiovascular |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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| measurement of dyspnoea quantified by the modified Medical Research Council (mMRC) Dyspnea Scale (grades from 0 to 4 ) | measures perceived respiratory disability indicating the extent to which their breathlessness affects their mobility - dyspnoea is assessed by accepted questionnaires typically used for COPD patients at baseline- grade <2 indicates better outcome and prognosis but grade = or >2 indicates poor outcome and prognosis. | Baseline |
| Measurement of FEV1 | For assessment of which degrees of severity of COPD are more related to development of COPD with pulmonary hypertension. | Baseline |
| Measurement of Breathing reserve during cardiopulmonary exercise testing | The breathing reserve in % is assessed at the end of the cardiopulmonary exercise testing to characterize a ventilatory limitation of the exercise test. It is calculated as percent from the minute ventilation in relation to the maximum mandatory ventilation. The measurement is a routine measurement during cardiopulmonary exercise testing. | Baseline |
| Measurement of Oxygen pulse during cardiopulmonary exercise testing | Baseline |
| Presence of cardiovascular comorbidities | For the cardiopulmonary characterization clinical characteristics, lung function, blood gases, laboratory investigation, ECG and echocardiography were used in addition to cardiopulmonary exercise testing. | Baseline |
| 21119187 | Background | Habib G, Torbicki A. The role of echocardiography in the diagnosis and management of patients with pulmonary hypertension. Eur Respir Rev. 2010 Dec;19(118):288-99. doi: 10.1183/09059180.00008110. |
| 17960052 | Background | Holverda S, Bogaard HJ, Groepenhoff H, Postmus PE, Boonstra A, Vonk-Noordegraaf A. Cardiopulmonary exercise test characteristics in patients with chronic obstructive pulmonary disease and associated pulmonary hypertension. Respiration. 2008;76(2):160-7. doi: 10.1159/000110207. Epub 2007 Oct 25. |
| D020969 |
| Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D003948 | Diagnostic Techniques, Respiratory System |
| D016552 | Ergometry |
| D008919 | Investigative Techniques |
| D057791 | Cardiac Imaging Techniques |
| D003952 | Diagnostic Imaging |
| D014463 | Ultrasonography |
| D001774 | Blood Chemical Analysis |
| D019963 | Clinical Chemistry Tests |
| D019411 | Clinical Laboratory Techniques |
| D004568 | Electrodiagnosis |