Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis
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2021Metadata
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Torres Castro, Rodrigo Hernán
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Effect of pulmonary hypertension on exercise tolerance in patients with COPD: a prognostic systematic review and meta-analysis
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Abstract
Background Pulmonary hypertension (PH) is a frequent complication in patients with COPD.
Objective To determine if, in patients with COPD, the presence of PH decreases exercise tolerance.
Methods We included studies that analysed exercise tolerance using a cardiopulmonary exercise test
(CPET) in patients with COPD with PH (COPD-PH) and without PH (COPD-nonPH). Two independent
reviewers analysed the studies, extracted the data and assessed the quality of the evidence.
Results Of the 4915 articles initially identified, seven reported 257 patients with COPD-PH and 404
patients with COPD-nonPH. The COPD-PH group showed differences in peak oxygen consumption
(V′O2peak), −3.09 mL·kg−1·min−1 (95% CI −4.74 to −1.43, p=0.0003); maximum workload (Wmax),
−20.5 W (95% CI −34.4 to −6.5, p=0.004); and oxygen pulse (O2 pulse), −1.24 mL·beat−1 (95% CI
−2.40 to −0.09, p=0.03), in comparison to the group with COPD-nonPH. If we excluded studies with lung
transplant candidates, the sensitivity analyses showed even bigger differences: V′O2, −4.26 mL·min−1·kg−1
(95% CI −5.50 to −3.02 mL·kg−1·min−1, p<0.00001); Wmax, −26.6 W (95% CI −32.1 to −21.1 W,
p<0.00001); and O2 pulse, −2.04 mL·beat−1 (95% CI −2.92 to −1.15 mL·beat−1, p<0.0001).
Conclusion Exercise tolerance was significantly lower in patients with COPD-PH than in patients with
COPD-nonPH, particularly in nontransplant candidates.
Patrocinador
Instituto de Salud Carlos III PI17/1515
Fondo Europeo de Desarrollo Regional (FEDER), Union Europea "Una manera de hacer Europa"
Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR)
Societat Catalana de Pneumologia (SOCAP)
National Agency for Research and Development (ANID)/Scholarship Program/DOCTORADO BECAS CHILE 2018-72190117
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Eur Respir Rev 2021; 30: 200321
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