scholarly journals Renin angiotensin system and pulmonary hemodynamics in chronic obstructive pulmonary disease

2018 ◽  
Vol 5 (2) ◽  
pp. 404
Author(s):  
Preeti Chauhan ◽  
Rajesh Chetiwal

Background: Pulmonary hypertension in chronic obstructive pulmonary disease (COPD) due to chronic alveolar hypoxia is probably the main contributor to the pathogenesis of pulmonary hypertension in COPD.  Angiotensin II is a potent vasoconstrictor in renin angiotensin aldosterone system (RAAS), it has been shown to promote growth response in vascular smooth muscle cell contributing towards pulmonary hypertension. So, the Echocardiographicaliy measured MPAP and its correlation with RAAS in patients of COPD was evaluated.Methods: A prospective observational study was done in 32 patients with COPD and 10 age matched healthy, non-smoker subject included as controls. Stable patients requiring no change in their medication in the previous four weeks and not having had an acute exacerbation in that period were included. MPAP was calculated. Measurement of Ang II and aldosterone was done.Results: Thirty-two cases of COPD, meeting inclusion criteria were enrolled comprising of 32 males and the mean age of patients ±2sd was (55.6 ±16.8), while mean age of controls ± 2sd was 49.60 ±5.56. Arterial blood gas analysis, PaO2 was ranged from (mean±2sd 75.44±12.1), PaCo2 ranged from (mean ±2sd 41.36±3.79) and SpO2 ranged from (mean±2sd 94.03 2±.74). Mean ±2sd of plasma Ang II in COPD cases was (4.9±3.8) ng/dl, significantly higher in comparison with controls (p < 0.001). Mean ±2sd of plasma ACE activity was (51.12±26.9) in COPD. Mean ±2sd of plasma aldosterone was (182.35±364.2) in COPD cases with significant (p<0.01). The MPAP in COPD cases was (mean±2sd 34.53±7.70).Conclusions: Use of Doppler has the advantage of being noninvasive and has been shown to be extremely reproducible in evaluation of MPAP and CO. The increased level of Ang II with increase MPAP in the present study would suggest that this may be a suitable model for investigating effects of novel vasodilator drugs for the treatment of pulmonary hypertension developed due to COPD.

Author(s):  
Valentin Calancea ◽  

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD is frequently associated with comorbidities, the most common complication being pulmonary hypertension and subsequent right heart failure. The prevalence of pulmonary hypertension and the pathophysiological processes of its installation in patients with COPD remain insufficiently studied, although it is known that its share increases with the severity of COPD, and its rate has been reported ranging from 20% to 90%. in the article, the author summarizes the notorious international discoveries and local contributions in this field, elucidating the opportunities, challenges and perspectives of studying the problem. Multiple investigations conducted in the last three decades by local researchers have deepened the knowledge of the pathophysiology, clinic, diagnosis, treatment and prophylaxis of pulmonary hemodynamic and cardiac function disorders in patients with COPD. Further investigations in this area are needed.


2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Sally youssef Hamada ◽  
Mohamed Saeed El Hoshy ◽  
Mona Saeed El Hoshy ◽  
Heba Ahmed Eshmawey ◽  
Heba Said Gharraf

Abstract Background Pulmonary hypertension (PH) is one of the most common complications of chronic obstructive pulmonary disease (COPD). PH in COPD is caused by many factors mainly hypoxia. Aim The aim was to assess prevalence and predictors of PH in COPD patients. Patients and methods A prospective, observational study was carried out on 100 patients diagnosed with COPD admitted at chest department of Alexandria university hospitals and Al. Mamoura chest hospital. All patients were subjected to complete medical history taking (Age, sex, smoking index, history of previous hospital admission for COPD exacerbation and history of previous ICU admission for the same reason), routine laboratory investigations including complete blood count (CBC), arterial blood gases (ABG), pulmonary function test (FEV1, FVC, FEV1/FVC ratio), Body mass index(BMI), six minute walk test, COPD assessment test (CAT) score, dyspnea assessment by modified Medical Research Council(m MRC) and Echocardiography relevant data (right atrial area, left atrial size, ejection fraction, valvular heart disease, PH, right ventricular function TAPSE (Tricuspid annular plane systolic excursion), systolic pulmonary artery pressure (SPAP) and tricuspid regurge velocity if present. Results A total of 100 COPD patients were included in the study 88 (88%) were males and 12 (12%) were females. Among patients with pulmonary hypertension 32 (94.1%) were males and 2 (5.9%) were females. On the other hand, 84.8%(n = 56) of patients without PH were males and 15.2%(n = 10) were females. Mean ± SD age of the patients was 60.12 ± 8.59 years. Mean ±SD age of the patients with pulmonary hypertension was 61.26±7.97 years, and for patients without PH mean± SD was 59.53 ± 8.88 years. With no statistically significant difference between the two groups. PH was diagnosed in 34 (34%) of patients, m PAP ≥25mmHg, of whom11 (32.4%) showed severe PH m PAP ≥40mmHg, 23 (67.6%) mild, moderate PH. Conclusion Although, the most important factors predicting PH in COPD patients were FEV1 and EF, respectively, but in COPD patients with severe PH was FEV1.


Respiration ◽  
1985 ◽  
Vol 47 (3) ◽  
pp. 164-170 ◽  
Author(s):  
Marco Soroldoni ◽  
Fulvia Ferrarini ◽  
Enrico Biffi ◽  
Marzio Pozzi ◽  
Roberto Gatto ◽  
...  

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