Pulmonary pressure increases during acute exacerbation in COPD and clinical outcome

Elevated pulmonary pressures can lead to right ventricular dysfunction, worsen respiratory status and increase overall morbidity in COPD patients. Yet, little is known about the impact of right-sided pressure changes during acute exacerbation in COPD (AECOPD) on patient outcomes. Our aim was to determine whether pulmonary pressures are elevated during AECOPD compared with the stable phase and to investigate the association between tricuspid regurgitation (TR) gradient during AECOPD and days alive and out of hospital (DAOH).

This was a multicentre, prospective study of pulmonary pressures changes in patients with AECOPD and stable-phase COPD. Inclusion criteria were diagnosis of COPD and admission with AECOPD. Transthoracic echocardiography (TTE), including TR gradient, tricuspid annular plane systolic excursion (TAPSE), right ventricular diameter and right atrial parameters, was performed during AECOPD and the stable phase.

Of 250 patients, 232 underwent TTE during AECOPD and 107 completed stable-phase follow-up. Reasons for incomplete follow-up included death (n=46), withdrawal (n=23), poor TTE quality (n=21) and unmeasurable TR gradients (n=35). TR gradient increased significantly during AECOPD, with a mean difference of 6.0 (95% CI 2.5-9.6) mmHg, while TAPSE, right ventricular diameter and right atrial size showed no significant changes. Higher TR gradients during AECOPD correlated with lower DAOH.

TR gradients were significantly elevated during AECOPD, suggesting that transient right-sided pressure spikes are associated with COPD exacerbations. However, the direction of this association remains unclear and further research is needed to determine whether right-sided pressure changes contribute to exacerbations or whether exacerbations themselves drive these pressure spikes.