[Clinical aspects of precapillary pulmonary hypertension]

Cor pulmonale is present in 54-64% of patients with respiratory failure (mean PaO2: 52-54 Torr) receiving home oxygen therapy in Japan. This may imply that the development of clinical symptoms of cor pulmonale in the course of the disease more strongly reflects far advanced stage than the presence of respiratory failure. In this paper, clinical data from subjects with various forms of precapillary pulmonary hypertension were analysed with respect to correlation between the prognosis and the pulmonary vascular response to various therapeutic modalities such as acute administration of oxygen, vasodilator drugs, and surgery. The results were as follows: 1) In subjects with COPD, there was a significant correlation between mean pulmonary arterial pressure (PPA) and prognosis. Patients who showed decreased pulmonary vascular resistance (% delta PVR less than -10) after 100% oxygen inhalation had a good prognosis. 2) In subjects with sequelae of pulmonary tuberculosis, there was no apparent correlation between the prognosis and % delta PVR after 100% oxygen inhalation. 3) In subjects with both COPD and sequelae of pulmonary tuberculosis, the lowest value of desaturation during sleep was significantly correlated to the PPA during wake. 4) Analysis of 232 cases with primary pulmonary hypertension revealed the following prognostic factors: PPA, cardiac output, stroke volume index, pulmonary vascular resistance, mixed venous oxygen tension, right atrial pressure, total bilirubin, and total protein.(ABSTRACT TRUNCATED AT 250 WORDS)