Noninvasive Prediction of Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease by Echocardiography With & It's Co-Relation With the Disease Severity (Hospital Based Study)

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of most common cause of death. Pulmonary hypertension, one of the major and under diagnosed complications of COPD which have a great impact on outcome of COAD and associated with frequent exacerbations and bad prognosis. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate changes related to pulmonary hypertension in COAD.

OBJECTIVE OF STUDY: Study pulmonary artery systolic pressure and Tricuspid annular plane systolic excursion in patients with COAD by 2D ECHO Doppler and correlate them with COPD severity.

METHOD: Cross sectional study was conducted on 50 COPD patients in Baghdad teaching hospital (age>40 year) from first of January to the end of June, 2017. First, the diagnosis of COPD was confirmed and evaluated for staging by history, clinical examination, and spirometery.

All patients have undergone ECG and 2D echocardiography and systolic pulmonary artery pressure and Tricuspid Annular Plane Systolic Excursion (TAPSE) were calculated. Patients with other cardiac or respiratory problems (asthma, pulmonary TB, lung malignancy, connective tissue diseases, interstitial lung disease, and cardiac ischemia, left side heart failure) were excluded from this study.

RESULTS: Study of PASP by TR jet with the use of 2D ECHO on 50 patients with COPD showed that 20 patients had normal echo study , mild increase in PASP was found in 15 patients, moderate 11, and severe increase in 4 patients.

Study of TAPSE by 2D ECHO showed that 35 patients had normal TAPSE values, while others 15 had abnormal values classified as mild, moderate, and severe: 3, 9, and 3, respectively.

A significant associations between echo findings of increasing PASP and abnormal TAPSE, with decrease in FEV1, and oxygen saturation measured by pulse oximeter, duration since COPD was diagnosed and MRC dyspnea scale.

CONCLUSION: High incidence of pulmonary hypertension with increasing severity of COAD. Echocardiography is useful and effective tool for detection of PHT secondary to COPD.