Features of pulmonary hypertension associated with COPD:
(1) usually mild when the COPD is stable but worsening during an exacerbation
(2) may show a disproportionate rise following exercise
(3) may be associated with a worse prognosis
Parameters:
(1) peak velocity of tricuspid regurgitation in m/s by Doppler ultrasonography
(2) clinical findings relative to FEV1
(3) mean pulmonary arterial pressure (MPAP) in mm Hg at rest by right heart catheterization
(4) mean pulmonary arterial pressure (MPAP) in mm Hg during exercise by right heart catheterization
(5) cardiac output (CO) at rest by right heart catheterization
(6) cardiac output (CO) during exercise by right heart catheterization
Indications for performing right heart catheterization - one of the following:
(1) peak velocity of tricuspid regurgitation >= 3.5 m/s
(2) severe dyspnea that cannot be explained by the FEV1 or other finding
Criteria for the diagnosis of pulmonary hypertension based on findings seen on right heart catheterization:
(1) mean pulmonary artery pressure >= 35 mm Hg at rest
(2) mean pulmonary artery pressure during exercise doubling to >= 35 mm Hg without doubling of the cardiac output (post-exercise MPAP >= 35; ratio of post-exercise to pre-exercise MPAP >= 2; ratio of post-exercise to pre-exercise CO < 2).
Conditions that exclude the diagnosis of COPD-related PH:
(1) presence of an alternative explanation for the pulmonary hypertension
(2) elevated pulmonary artery wedge pressure (PAWP >= 15 mm Hg, indicative of left-sided heart disease)
