Tuesday, January 06, 2015

Pulmonary hypertension in chronic lung disease

From a State-of-the-Art paper in JACC:

The prevalence of pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) depends on the severity of the disease and the definition of PH (see discussion in the following text). Several studies in patients with the previous GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage IV showed that up to 90% of these patients have a mean pulmonary artery pressure (mPAP) of greater than 20 mm Hg, with most ranging between 20 and 35 mm Hg and ∼3% to 5% patients with mPAP greater than 35 to 40 mm Hg...
In idiopathic pulmonary fibrosis (IPF), which has a survival range of only 2.5 to 3.5 years, mPAP values of greater than 25 mm Hg were reported in 8.1% and 14.9% of patients, respectively, upon initial workup (9,). Higher percentages are found in advanced (30% to 50%) and end-stage (greater than 60%) IPF cases (11,12,13). Among these, a small percentage may present with mPAP values greater than 40 mm Hg (∼9% 14)...
Combined pulmonary fibrosis and emphysema (CPFE) patients are particularly prone to PH development, with estimates approaching 30% to 50%.

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