The role of pulmonary arterial stiffness in COPD

Jonathan R. Weir-McCall (Lead / Corresponding author), Allan D. Struthers, Brian J. Lipworth, J. Graeme Houston

    Research output: Contribution to journalReview articlepeer-review

    27 Citations (Scopus)
    155 Downloads (Pure)

    Abstract

    COPD is the second most common cause of pulmonary hypertension, and is a common complication of severe COPD with significant implications for both quality of life and mortality. However, the use of a rigid diagnostic threshold of a mean pulmonary arterial pressure (mPAP) of ≥25mHg when considering the impact of the pulmonary vasculature on symptoms and disease is misleading. Even minimal exertion causes oxygen desaturation and elevations in mPAP, with right ventricular hypertrophy and dilatation present in patients with mild to moderate COPD with pressures below the threshold for diagnosis of pulmonary hypertension. This has significant implications, with right ventricular dysfunction associated with poorer exercise capability and increased mortality independent of pulmonary function tests.The compliance of the pulmonary artery (PA) is a key component in decoupling the right ventricle from the pulmonary bed, allowing the right ventricle to work at maximum efficiency and protecting the microcirculation from large pressure gradients. PA stiffness increases with the severity of COPD, and correlates well with the presence of exercise induced pulmonary hypertension. A curvilinear relationship exists between PA distensibility and mPAP and pulmonary vascular resistance (PVR) with marked loss of distensibility before a rapid rise in mPAP and PVR occurs with resultant right ventricular failure. This combination of features suggests PA stiffness as a promising biomarker for early detection of pulmonary vascular disease, and to play a role in right ventricular failure in COPD. Early detection would open this up as a potential therapeutic target before end stage arterial remodelling occurs.

    Original languageEnglish
    Pages (from-to)1381-1390
    Number of pages10
    JournalRespiratory Medicine
    Volume109
    Issue number11
    Early online date12 Jun 2015
    DOIs
    Publication statusPublished - Nov 2015

    Keywords

    • Chronic obstructive
    • Hypertension
    • Pulmonary
    • Pulmonary disease
    • Pulmonary heart disease
    • Vascular capacitance
    • Vascular resistance

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