Pneumologie 2015; 69 - P27
DOI: 10.1055/s-0035-1551929

Impact of cardiopulmonary comorbidities on pulmonary hemodynamics

P Douschan 1, 2, G Kovacs 1, 2, V Foris 1, 2, A Olschewski 2, H Olschewski 1, 2
  • 1Division of Pulmonology, Medical University Graz, Austria
  • 2Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria

Introduction: Cardiopulmonary comorbidities are known risk factors for pulmonary hypertension (PH) and may contribute to pulmonary arterial pressure (PAP) elevation. However, in clinical practice it is difficult to differentiate whether these conditions should be considered as coexisting comorbidities in the setting of PH or as the underlying cause for PH.

Methods: We analysed the number of cardiopulmonary comorbidities, recorded in our data archive, from patients undergoing right heart catheterization in our clinic between 2006 and 2014. Patients were stratified into five groups according to their mean PAP values. Above the 25 mmHg mPAP cut-off, tertile ranks were used to create three homogenous groups of different stages of severity: (< 20 mmHg: normal PAP, 21 – 24 mmHg: borderline-, 25 – 35 mmHg: mild-, 36 – 48 mmHg: moderate-, ≥49 mmHg: severe PH). In-between group comparisons were performed by Kruskal-Wallis-Tests and adjusted U-Tests.

Results: 547 patients were included (64% female, age: 62 ± 14yr, mean PAP: 29.6 ± 15.1 mmHg). A statistically significant difference regarding number of cardiopulmonary comorbidities across the PAP-groups was found (normal PAP: 1.04 ± 0.91 comorbidities, borderline: 1.66 ± 1.07, mild: 2.06 ± 1.10, moderate: 2.19 ± 1.30, severe: 1.57 ± 1.28), p = 0.0001. Patients with no PH and those with severe PH had significant lower numbers of cardiopulmonary comorbidities as compared to those with mild- and moderate PH. Subgroup analysis of PAH patients revealed significant differences between patients without PH and patients with borderline (p = 0.0001) or mild PAH (p = 0.006), but showed no significant difference between patients without PH and those with severe PAH (p = 1.00).

Conclusion: Patients suffering from borderline, mild and moderate stages of PH had significant higher frequencies of cardiopulmonary comorbidities as compared to patients with severe pulmonary hypertension. This may support that severe PH might be considered as an isolated pulmonary vascular disease, while mild to moderate PH might represent a pulmonary vascular manifestation of multi-organ disorders.