Profiles of patients with pulmonary hypertension associated with chronic obstructive pulmonary disease (PH-COPD)

Pulmonary hypertension (PH) can be associated with COPD. Low screening rates contribute to poor characterization of these patients. This study compared key clinical characteristics of COPD patients with and without PH. Between 2015-2019 at Mayo Clinic, 3118 PH-COPD patients were identified in electronic health records, defined by 1) mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization (RHC) or tricuspid regurgitation velocity (TRV) >3.4 m/s via echocardiogram (Echo), 2) COPD diagnosis before or ≤3 months after PH diagnosis, and 3) no Group 1, 2, or 4 PH. A COPD only cohort of 6248 patients without PH was identified with mPAP ≤20 mmHg on all RHCs and no TRV >3.4 m/s, or if no RHC, all TRV ≤2.8 m/s. Demographics, symptoms, comorbidities, treatments, and diagnostic tests were summarized for the year prior to PH diagnosis (PH-COPD) or latest negative screening procedure (COPD only). Cohorts were similar with respect to race and sex and only small differences were observed between symptoms. The largest differences were found for laboratory tests: NT-proBNP (PH-COPD vs COPD-only mean: 4151 vs 1468pg/mL), creatinine (1.32 vs 1.01mg/dL), hemoglobin (11.5 vs 12.5g/dL), erythrocyte distribution width (15.3 vs 14.4%); and Echo/ECG measurements: LV mass (219 vs 180g), LV mass index (112 vs 95g/m2), LA volume (84.8 vs 66.2mL), RVSP (45.9 vs 31.5mmHg), RA volume (73.3 vs 52.0mL), RA volume index (37.6 vs 27.7mL/m2), and QRS duration (106 vs 94.6ms), with all p<0.001. These findings indicate PH-COPD patients have distinct clinical profiles and further understanding of this group will help clinicians identify patients who may benefit from PH-COPD screening.