| Autor: |
Elkhapery A; Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA., Hammami MB; Department of Internal Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, New York, NY 10461, USA., Sulica R; Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, New York University Grossman School of Medicine and NYU Langone Health, New York, NY 10016, USA., Boppana H; Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA., Abdalla Z; Rochester General Hospital Research Institute, Rochester, NY 14621, USA., Iyer C; Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA., Taifour H; Department of Internal Medicine, Unity Hospital, Rochester, NY 14626, USA., Niu C; Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA., Deshwal H; Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26505, USA. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of cardiovascular development and disease [J Cardiovasc Dev Dis] 2023 Dec 16; Vol. 10 (12). Date of Electronic Publication: 2023 Dec 16. |
| DOI: |
10.3390/jcdd10120498 |
| Abstrakt: |
Background: Chronic obstructive pulmonary disease-associated pulmonary hypertension (PH-COPD) results in a significant impact on symptoms, quality of life, and survival. There is scant and conflicting evidence about the use of pulmonary hypertension (PH) specific therapy in patients with PH-COPD. Study Design and Methods: PubMed, OVID, CINAHL, Cochrane, Embase, and Web of Science were searched using various MESH terms to identify randomized controlled trials (RCTs) or observational studies investigating PH-specific therapies in patients with severe PH-COPD, defined by mean pulmonary artery pressure (mPAP) of more than 35 mm Hg or pulmonary vascular resistance (PVR) of more than 5 woods units on right heart catheterization. The primary outcome was a change in mPAP and PVR. Secondary outcomes were changes in six-minute walk distance (6MWD), changes in the brain-natriuretic peptide (BNP), New York Heart Association (NYHA) functional class, oxygenation, and survival. Results: Thirteen studies satisfied the inclusion criteria, including a total of 328 patients with severe PH-COPD. Out of these, 308 patients received some type of specific therapy for PH. There was a significant reduction in mPAP (mean difference (MD) -3.68, 95% CI [-2.03, -5.32], p < 0.0001) and PVR (MD -1.40 Wood units, 95% CI [-1.97, -0.82], p < 0.00001). There was a significant increase in the cardiac index as well (MD 0.26 L/min/m 2 , 95% CI [0.14, 0.39], p < 0.0001). There were fewer patients who had NYHA class III/lV symptoms, with an odds ratio of 0.55 (95% CI [0.30, 1.01], p = 0.05). There was no significant difference in the 6MWD (12.62 m, 95% CI [-8.55, 33.79], p = 0.24), PaO 2 (MD -2.20 mm Hg, 95% CI [-4.62, 0.22], p = 0.08), or BNP or NT-proBNP therapy (MD -0.15, 95% CI [-0.46, 0.17], p = 0.36). Conclusion: The use of PH-specific therapies in severe PH-COPD resulted in a significant reduction in mPAP and PVR and increased CI, with fewer patients remaining in NYHA functional class III/IV. However, no significant difference in the 6MWD, biomarkers of right ventricular dysfunction, or oxygenation was identified, demonstrating a lack of hypoxemia worsening with treatment. Further studies are needed to investigate the use of PH medications in patients with severe PH-COPD. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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