The Value Of Cardiopulmonary Exercise Test In Screening And Evaluation Of COPD With Pulmonary Hypertension

Objective:This study was aimed to investigate the value of cardiopulmonary exercise test(CPET)in screening and evaluating chronic obstructive pulmonary disease(COPD)with pulmonary hypertension(PH)Methods:We retrospectively analyzed 76 COPD patients,who were diagnosed by routine pulmonary function test(PFTs),right cardiac catheterization(RHC),while evaluated by CPET from June 2012 to January 2019 in Shanghai Pulmonary Hospital Their demographic characteristics and clinical data were collected for research.Logistic regression analysis was used to screen CPET parameters to predict the patients with COPD with PH(COPD-PH).And partial regression was used to analyze the correlation between CPET parameters and RHC parameters.Results:1.Comparison of clinical features between patients with COPD and borderline COPD-PH1)Comparison of general data:There was no difference in age,sex ratio,BMI and so on.The borderline COPD-PH group was more complicated with hyperlipidemia,p<0.05.PFTs showed that the pulmonary reserve function of borderline COPD-PH patients decreased significantly(MVV),p<0.052)Comparison of CPET parameters:CPET showed that the metabolic function(VO2)and ventilatory effectiveness(VE,VCO2)of borderline COPD-PH patients decreased significantly at anaerobic threshold(AT),p<0.05.2.Comparison of clinical features between COPD-nonPH and COPD-PH patients.The percentage of female patients in COPD-PH group was higher than that in COPD-PH group,p<0.05.PFTs showed that the diffusion capacity of COPD-PH group decreased(DLCO%pred),p<0.05.3.Comparison of COPD-PH subgroup data1)Comparison of general characteristics:There were more patients with hypertension in mild COPD-PH,p<0.05.The proportion of women in severe COPD-PH group was higher,p<0.052)Comparison of cardiopulmonary exercise test parameters:The ventilation effectiveness(VE/VCO2 slope,OUEP,OUEs)of patients with severe COPD-PH was poor,and the residual of respiratory reserve(BR)was large,p<0.05.4.The value of cardiopulmonary exercise test in predicting severe COPD-PH patients.Single-factor and multi-factor Logistic regression analysis was used to construct the index of predicting severe COPD-PH(CPET-PI).1)Prediction in patients with COPD:CPET-PI(1)=-5.111+0.043*peak HR-0.604*peak O2pulse+0.058*VE/VCO2,the sensitivity of it was satisfactory and the specificity of it was excellent.2)Prediction in patients with COPD-PH:CPET-PI(2)=2.073-0.096*OUEP.The sensitivity of it was excellent and the specificity of it was satisfactory.5.Correlation between cardiopulmonary exercise test and severity of COPD-PHPartial regression analysis of CPET and RHC parameters showed that RER and VE/VCO2 slope were negatively correlated with CI in patients with COPD-PH during peak exercise period,while OUEP and OUES were positively correlated with it.There was a moderate positive correlation between VE/VCO2,Nardio VE/VCO2,VE/VCO2 slope and PVR.Conclusion:CPET had a good recognition effect on severe COPD-PH:the cardiac function and ventilation effectiveness of patients with severe COPD-PH were significantly decreased.Many parameters of CPET were moderately correlated with CI and PVR,which were the result of RHC of COPD-PH,suggesting that CPET can better evaluate the severity of COPD-PH.