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Effect of Diuretic Therapy on Pulmonary Hypertension in COPD

Peter Engel


R. Baughman

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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Engel P1, Baughman RP2

1The Christ Hospital Heart & Vascular Center , Cincinnati OH 2Department of Internal Medicine, University of Cincinnati, Cincinnati OH

BACKGROUND: Elevated right atrial pressure (RAP) is generally considered a sign of right ventricular failure(RVF) and poor prognosis in patients with pulmonary arterial hypertension (PAH). In most studies of PAH , elevated RAP does not respond to therapy with diuretics and pulmonary vasodilators (Gomberg-Maitland M et al JACC 2011:57:1053-61), We evaluated four patients referred for evaluation of pulmonary hypertension (PH) with COPD and volume overload and elevated RAP with serial right heart ctaheterization (RHC) before and after therapy with diuretics alone.

METHODS: Four patients were studied: 3 male, 1 female, age 45-61 yr. Severe COPD was found in all, with FEV1 19-58% predicted and FEV1/FVC ratio 32-69%. RV/TLC was > 40% in 3/4 pts. At baseline, RAP, mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance (PVR) were markedly elevated and pulmonary wedge pressure (PAWP) was mildly to moderately elevated (< 15 mmHg in 3/4 pts). Diuretic therapy resulted in an average weight loss of 28 lb. RHC was repeated 6-90 days after initiation of diuretic therapy.

RESULTS: After diuretic therapy RAP and PVR decreased dramatically (figs). MPAP and PAWP decreased significantly as well.. Two of the patients were being considered for parenteral prostanoid therapy, but all pts were able to be managed with oral therapy alone, with two pts. on diuretic therapy alone. One pt had a large pericardial effusion, which resolved completely after diuretics.

CONCLUSION: Elevated RAP in some pts with COPD and PH may be related to hyperinflation and increased intrthoracic (extracardiac) pressure and not to RVF. Diuretic therapy alone may effect major chnages in the hemodynamic profile of these pts and should be given before decisions regarding medical therapy of PH are made.

Effect of Diuretic Therapy on Pulmonary Hypertension in COPD: Figure 1 

Effect of Diuretic Therapy on Pulmonary Hypertension in COPD: Figure 2   

Effect of Diuretic Therapy on Pulmonary Hypertension in COPD: Figure 3