Key result
Echocardiographic signs of pulmonary hypertension were found in 14% of stable COPD out-patients and were associated with higher mortality (HR 2.7; p=0.037).
Why the study?
Can NT-proBNP be used as a first-line screening tool to rule out echocardiographic signs of pulmonary hypertension in stable COPD out-patients?
Observational (n=117)
Can NT-proBNP be used as a first-line screening tool to rule out echocardiographic signs of pulmonary hypertension in stable COPD out-patients?
An NT-proBNP level below 95 ng/l can effectively rule out echocardiographic signs of pulmonary hypertension in stable COPD patients, potentially streamlining screening protocols.
Echocardiographic PH signs were associated with higher mortality in stable COPD outpatients; hypothesis-generating for screening but should not yet change practice.
UNLABELLED: Pulmonary hypertension (PH) worsens the prognosis in chronic obstructive pulmonary disease (COPD). The diagnosis of PH is established by right heart catheterisation (RHC), while echocardiography can be used for screening. We aimed to asses the outcome of echocardiographic screening for PH in a group of stable COPD out-patients, and to evaluate NT-proBNP as a first line screening tool. Criteria for PH on echocardiography were a tricuspid regurgitation pressure gradient > 40 mmHg, a tricuspid annular plane systolic excursion < 1.8 cm or right ventricular dilatation. Positively screened patients were asked to undergo RHC. Results (Mean ± SEM): 16 of 117 patients (14%) had PH on echocardiography. They had a higher mortality (hazard ratio for death: 2.7 ± 1.3, p = 0.037) and lower six minute walk test (224 ± 33 vs. 339 ± 15, p = 0.006). NT-proBNP below 95 ng/l excluded PH on echocardiography with a negative predictive value of 100 (95% CI: 89-100%). RHC was obtained in six patients screened positive. In three of these, PH was not confirmed. CONCLUSIONS: Signs of PH on echocardiography as defined here was found in 14% and had prognostic significance in COPD. A value of NT-proBNP less than 95 ng/l may be used to exclude signs of PH.
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Andersen et al. (2012) conducted an observational in Chronic obstructive pulmonary disease (COPD) (n=117). Echocardiographic signs of pulmonary hypertension vs. No echocardiographic signs of pulmonary hypertension was evaluated on Death (HR 2.7, p=0.037). Echocardiographic signs of pulmonary hypertension were found in 14% of stable COPD out-patients and were associated with higher mortality (HR 2.7; p=0.037).
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