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Utility of FVC/DLCO ratio to stratify the risk of mortality in unselected subjects with pulmonary hypertension

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Abstract

In patients with systemic sclerosis, a ratio between forced vital capacity (FVC) and diffusing capacity of carbon monoxide (DLCO, FCV%/DLCO%) >1.5 might be a predictor of pulmonary hypertension (PH). The aim of this study is, therefore, to evaluate whether this index can be used in patients with PH, regardless of etiology. 83 consecutive outpatients with suspected PH at non-invasive work-up underwent spirometry and DLCO test before right heart catheterization (RHC); FVC%/DLCO% ratio was then calculated and compared with mean pulmonary-artery-pressure (mPAP) and mortality at 5-year follow-up. Significant correlations between FVC%/DLCO% and PAsP and mPAP levels were found (p < 0.05). After ROC curve analysis and definition of best cut-off values for PAsP and FVC%/DLCO%, increased mPAP values at RHC were observed comparing subjects with both PAsP and FVC%/DLCO% values below cut off values (−/−), either PAsP or FVC%/DLCO% above cut off values (±), or both above (+/+) (p < 0.05). Poorer survival rates are observed at follow-up with higher FVC%/DLCO% values (0% for <1, 17.4% for 1–3, 33.3% for >3, p < 0.05), when comparing subjects with either increased PAsP and FVC%/DLCO% values or both with those with lower (log-rank p < 0.05). Even in subjects with mPAP at RHC >25 mmHg, increased FVC%/DLCO% values predicted a worse outcome (p < 0.05). FVC%/DLCO% values are related to mPAP in subjects with suspected PH, and may further stratify the risk of mortality in addition to PAP.

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References

  1. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M (2015) ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J (pii ERJ-01032-2015)

  2. Iyer AS, Wells JM, Vishin S, Bhatt SP, Wille KM, Dransfield MT (2014) CT scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe COPD. Chest 145:824–832

    Article  PubMed  Google Scholar 

  3. Sivova N, Launay D, Wémeau-Stervinou L, De Groote P, Remy-Jardin M, Denis G, Lambert M, Lamblin N, Morell-Dubois S, Fertin M, Lefevre G, Sobanski V, Le Rouzic O, Hatron PY, Wallaert B, Hachulla E, Perez T (2013) Relevance of partitioning DLCO to detect pulmonary hypertension in systemic sclerosis. PLoS One 8:e78001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sidhu B, Hashemi N, Rashidian A, Sharma S, Gill N, Mills P, Balasubramanian V (2015) Utility of pulmonary function testing in detection of pulmonary arterial hypertension. A58. Clinical evaluation of pulmonary hypertension. p A1875 (First published online 17 Feb 2015)

  5. Hsu VM, Chung L, Hummers LK, Wigley F, Simms R, Bolster M, Silver R, Fischer A, Hinchcliff ME, Varga J, Goldberg AZ, Derk CT, Schiopu E, Khanna D, Shapiro LS, Domsic RT, Medsger T, Mayes MD, Furst D, Csuka ME, Molitor JA, Alkassab F, Steen VD (2014) Development of pulmonary hypertension in a high-risk population with systemic sclerosis in the pulmonary hypertension assessment and recognition of outcomes in scleroderma (PHAROS) cohort study. Semin Arthr Rheum 44:55–62

    Article  Google Scholar 

  6. Al Plummer (2008) The carbon monoxide diffusing capacity: clinical implications, coding, and documentation. Chest 134:663–667

    Article  Google Scholar 

  7. Sun XG, Hansen JE, Oudiz RJ, Wasserman K (2003) Pulmonary function in primary pulmonary hypertension. J Am Coll Cardiol 41:1028–1035

    Article  PubMed  Google Scholar 

  8. Coghlan JG, Denton CP, Grünig E, Bonderman D, Distler O, Khanna D, Müller-Ladner U, Pope JE, Vonk MC, Doelberg M, Chadha-Boreham H, Heinzl H, Rosenberg DM, McLaughlin VV, Seibold JR, DETECT study group (2014) Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis 73:1340–1349

    Article  PubMed  Google Scholar 

  9. Chandra S, Shah SJ, Thenappan T, Archer SL, Rich S, Gomberg-Maitland M (2010) Carbon monoxide diffusing capacity and mortality in pulmonary arterial hypertension. J Heart Lung Transplant 29:181–187

    Article  PubMed  Google Scholar 

  10. Hoeper MM, Meyer K, Rademacher J, Fuge J, Welte T, Olsson KM (2016) Diffusion capacity and mortality in patients with pulmonary hypertension due to heart failure with preserved ejection fraction. JACC Heart Fail 4:441–449

    Article  PubMed  Google Scholar 

  11. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS (2001) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease [GOLD] Workshop summary. Am J Resp Crit Care Med 163:1256–1276

    Article  CAS  PubMed  Google Scholar 

  12. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CPM, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre M, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J (2005) Interpretative strategies for lung function tests. Eur Respir J 26:948–968

    Article  CAS  PubMed  Google Scholar 

  13. Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Gustafsson P, Hankinson J, Jensen R, McKay R, Miller MR, Navajas D, Pedersen OF, Pellegrino R, Wanger J (2005) Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 26:720–735

    Article  CAS  PubMed  Google Scholar 

  14. Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, Barst RJ, Ghofrani HA, Jing Z, Opitz C, Seyfarth H, Halank M, McLaughlin V, Oudiz RJ, Ewert R, Wilkens H, Kluge S, Bremer H, Baroke E, Rubin LJ (2006) Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol 48:2546–2552

    Article  PubMed  Google Scholar 

  15. Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, Yaici A, Weitzenblum E, Cordier JF, Chabot F, Dromer C, Pison C, Reynaud-Gaubert M, Haloun A, Laurent M, Hachulla E, Simonneau G (2006) Pulmonary arterial hypertension in France: results from a national registry. Am J Respir Crit Care Med 173:1023–1030

    Article  PubMed  Google Scholar 

  16. Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG (2011) Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL registry. Chest 140:19–26

    Article  PubMed  PubMed Central  Google Scholar 

  17. Galiè N, Rubin LJ, Hoeper MM, Jansa P, Al-Hiti H, Meyer GMB, Chiossig E, Kusic-Pajic A, Simonneau G (2008) Treatment of patients with mildly symptomatic pulmonary arterial hypertension with bosentan (EARLY study): a double-blind, randomised controlled trial. Lancet 371:2093–2100

    Article  PubMed  Google Scholar 

  18. Meyrick B, Reid L (1983) Pulmonary hypertension. Anatomic and physiologic correlates. Clin Chest Med 4:199–217

    CAS  PubMed  Google Scholar 

  19. Sun XG, Hansen JE, Oudiz RJ, Wasserman K (2003) Pulmonary function in primary pulmonary hypertension. J Am Coll Cardiol 41:1028–1035

    Article  PubMed  Google Scholar 

  20. Steen VD, Graham G, Conte C, Owens G, Medsger TA Jr (1992) Isolated diffusing capacity reduction in systemic sclerosis. Arthr Rheum 35:765–770

    Article  CAS  Google Scholar 

  21. Nathan SD, Shlobin OA, Ahmad S, Urbanek S, Barnett SD (2007) Pulmonary hypertension and pulmonary function testing in idiopathic pulmonary fibrosis. Chest 131:657–663

    Article  PubMed  Google Scholar 

  22. Thabut G, Dauriat G, Stern JB, Logeart D, Levy A, Marrash-Chahla R, Mal H (2005) Pulmonary hemodynamics in advanced COPD candidates for lung volume reduction surgery or lung transplantation. Chest 127:1531–1536

    Article  PubMed  Google Scholar 

  23. Chaouat A, Bugnet AS, Kadaoui N, Schott R, Enache I, Ducoloné A, Ehrhart M, Kessler R, Weitzenblum E (2005) Severe pulmonary hypertension in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 172:189–194

    Article  PubMed  Google Scholar 

  24. Weitzenblum E, Chaouat A (2005) Severe pulmonary hypertension in COPD: is it a distinct disease? Chest 127:1480–1482

    Article  PubMed  Google Scholar 

  25. Scharf SM, Iqbal M, Keller C, Criner G, Lee S, Fessler HE (2002) Hemodynamic characterization of patients with severe emphysema. Am J Respir Crit Care Med 166:314–322

    Article  PubMed  Google Scholar 

  26. Oswald-Mammosser M, Weitzenblum E, Quoix E, Moser G, Chaouat A, Carpentier C, Kessler R (1995) Prognostic factors in COPD patients receiving long-term oxygen therapy: importance of pulmonary artery pressure. Chest 107:1193–1198

    Article  CAS  PubMed  Google Scholar 

  27. D’Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, Fishman AP, Goldring RM, Groves BM, Kernis JT (1991) Survival in patients with primary pulmonary hypertension: results from a national prospective registry. Ann Intern Med 115:343–349

    Article  PubMed  Google Scholar 

  28. McLaughlin VV, McGoon MD (2006) Pulmonary arterial hypertension. Circulation 114:1417–1431

    Article  PubMed  Google Scholar 

  29. Chandra S, Shah SJ, Thenappan T, Archer SL, Rich S, Gomberg-Maitland M (2010) Carbon monoxide diffusing capacity and mortality in pulmonary arterial hypertension. J Heart Lung Transplant 29:181–187

    Article  PubMed  Google Scholar 

  30. Marini C, Formichi B, Bauleo C, Michelassi C, Pancani R, Prediletto R, Miniati M, Catapano G, Monti S, Mannucci F, Tavoni A, D’Ascanio A, Pastormerlo LE, Giannoni A, Giuntini C (2014) Improved survival in limited scleroderma-related pulmonary artery hypertension. Intern Emerg Med 9:385–396

    Article  PubMed  Google Scholar 

  31. Marini C, Formichi B, Bauleo C, Michelassi C, Airò E, Rossi G, Giuntini C (2016) Survival protection by bodyweight in isolated scleroderma-related pulmonary artery hypertension. Intern Emerg Med 11:941–952

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

    Lacedonia Donato & Carpagnano Giovanna Elisiana

  2. Hospital “F. Miulli”, Acquaviva Delle Fonti (Ba), Italy

    Galgano Giuseppe, Schino Pietro & Ventura Valentina

  3. Section of Cardiology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy

    Correale Michele, Natale Daniele Brunetti, Di Biase Matteo & Foschino Barbaro Maria Pia

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  1. Lacedonia Donato
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Correspondence to Natale Daniele Brunetti.

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All procedures performed in our studies were in accordance with ethical standards of the 1964 Helsinki declaration and its later amendments.

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This study does not contain any studies with human and animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Donato, L., Giovanna Elisiana, C., Giuseppe, G. et al. Utility of FVC/DLCO ratio to stratify the risk of mortality in unselected subjects with pulmonary hypertension. Intern Emerg Med 12, 319–326 (2017). https://doi.org/10.1007/s11739-016-1573-9

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  • DOI: https://doi.org/10.1007/s11739-016-1573-9

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