CPET in Evaluation of PH in COPD Patients
CPET in Evaluation of PH in COPD Patients
-  To evaluate the entire course of exercise during CPET in COPD patients.

 -  To study whether CPET, PFTs and arterial blood gases could discriminate between COPD
 patients with and without PH.

 -  To study whether the existence of pulmonary hypertension in COPD is related to
 characteristic findings in gas exchange and circulatory parameters during
 cardiopulmonary exercise testing (CPET).
(COPD) is a common cause of pre-capillary pulmonary hypertension (PH). Pulmonary hypertension
 (PHT) is a common complication of COPD and is determinant for the prognosis of COPD.

 PHT is defined as A mean PAP of ≥ 25 mmHg measured by right heart catheterization at rest.

 Exercise tolerance in patients with COPD is reduced due to ventilatory limitation, gas
 exchange abnormalities, and deconditioning as the disease progresses, and this may impair
 functional capacity and the quality of life.

 COPD patients usually terminate physical activity when the ventilatory requirement exceeds
 their maximal ventilatory capacity.

 If they have PH, the altered hemodynamic response may reduce their exercise capacity further.

 Nowadays, despite the fact that LTOT improves the survival of hypoxaemic patients, PH is
 still associated with lower survival rates . Importantly, an elevated Ppa was also associated
 with an increased risk of severe acute exacerbation in COPD patients with moderate-to-severe
 airflow limitation .

 Impaired exercise tolerance in COPD patients would suggest that cardiopulmonary exercise test
 (CPET) is a valuable tool to reveal whether they have PH or not.

 Transthoracic echocardiography (TTE) is one such tool and is widely available and safe. In
 addition to its role in diagnosis, it can be used to screen for high-risk patient
 populations, to assess prognosis and to monitor disease stability and response to treatment.
Inclusion Criteria:

 -  Stable COPD patients

 -  with age ≥ 40 years.

 -  Prior to inclusion, the COPD diagnosis was verified by spirometry before and after
 bronchodilation.

 -  treatment was optimized and Patients on regular medication.

 Exclusion Criteria:

 -  Patients who refuse to participate in the study.

 -  Patients underwent thorough pulmonary and cardiologic preinclusion screening, and
 those with pulmonary disease other than COPD and emphysema.

 -  arrhythmia

 -  valvular or coronary heart disease

 -  left ventricle dysfunction

 -  obstructive sleep apnea syndrome

 -  pulmonary embolism

 -  systemic hypertension ≥160/90 mmHg

 -  inflammatory disease

 -  hyperthyroidism

 -  renal failure

 -  inability to exercise (due to orthopedic, neurologic or musculoskeletal problem).