Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis. (29th April 2021)

• Record Type: Journal Article
• Authors: Torres-Castro, Rodrigo; Gimeno-Santos, Elena; Vilaró, Jordi; Roqué-Figuls, Marta; Moisés, Jorge; Vasconcello-Castillo, Luis; Orizaga, Tanya; Barberà, Joan Albert; Blanco, Isabel
• Is Part Of: European respiratory review. Volume 30:Number 160(2021)
• Publication Date: 2021-04-29
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Electronic journals; Periodical; Periodicals; Periodicals; 616.2
• DOI: 10.1183/16000617.0321-2020
• Languages: English
• ISSNs: 0905-9180

Abstract

Background: Pulmonary hypertension (PH) is a frequent complication in patients with COPD. Objective: To determine if, in patients with COPD, the presence of PH decreases exercise tolerance. Methods: We included studies that analysed exercise tolerance using a cardiopulmonary exercise test (CPET) in patients with COPD with PH (COPD-PH) and without PH (COPD-nonPH). Two independent reviewers analysed the studies, extracted the data and assessed the quality of the evidence. Results: Of the 4915 articles initially identified, seven reported 257 patients with COPD-PH and 404 patients with COPD-nonPH. The COPD-PH group showed differences in peak oxygen consumption ( V ′O2peak ), −3.09 mL·kg −1 ·min −1 (95% CI −4.74 to −1.43, p=0.0003); maximum workload (Wmax ), −20.5 W (95% CI −34.4 to −6.5, p=0.004); and oxygen pulse (O2 pulse), −1.24 mL·beat −1 (95% CI −2.40 to −0.09, p=0.03), in comparison to the group with COPD-nonPH. If we excluded studies with lung transplant candidates, the sensitivity analyses showed even bigger differences: V ′O2, −4.26 mL·min −1 ·kg −1 (95% CI −5.50 to −3.02 mL·kg −1 ·min −1, p<0.00001); Wmax, −26.6 W (95% CI −32.1 to −21.1 W, p<0.00001); and O2 pulse, −2.04 mL·beat −1 (95% CI −2.92 to −1.15 mL·beat −1, p<0.0001). Conclusion: Exercise tolerance was significantly lower in patients with COPD-PH than in patients with COPD-nonPH, particularly in nontransplant candidates. The V ′O2peak, Wmax and O2 pulse values were significantly lower in patients with COPD-PH than in patients with COPD-nonPH, particularly in nontransplant candidates https://bit.ly/3s5dtJ9