Chronic obstructive pulmonary disease in patients with chronic thromboembolic pulmonary hypertension: Prevalence and implications for surgical treatment outcome

Objective: The aim of our study was to investigate the prevalence of chronic obstructive pulmonary disease (COPD) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and examine their impact on the results of pulmonary thrombendarterectomy (PEA). Methods: We enrolled 136 patients with CTEPH who scheduled for elective PEA. Pulmonary function tests (PFTs) including full-body plethysmography with bronchodilation test and lung diffusion capacity assessment were performed in all patients prior to surgery treatment. The diagnosis of COPD was verified in accordance with the recommendations of the Global Initiative for Chronic Obstructive Lung Disease 2017. The effect of COPD on perioperative characteristics, complications, in-hospital and one-year mortality of patients with CTEPH were analysed. Results: In the study group with CTEPH the prevalence of COPD was 23%. In 13% of patients, COPD was first detected. The results of PFTs showed more severe airflow limitations with obstructive pattern in patients with concomitant COPD, as well as a more pronounced decrease in the lung diffusion capacity. The presence of COPD in patients with CTEPH significantly increases the risk of residual pulmonary hypertension in the early postoperative period of PEA (OR=6.2 (1.90-10.27), P=.002), duration of hospital stay (OR=1.1 (1.01-1.20), P=.020) and the risk of in-hospital mortality (OR=4.4 (1.21-16.19), P=.023). The lung diffusion capacity revealed significant negative associations with the duration of hospital stay and in-hospital mortality (OR 0.87 (0.74-0.98), P=.012). Conclusion: COPD in patients with CTEPH significantly increases the risk of residual pulmonary hypertension, in-hospital mortality and increases the duration of hospital stay after PEA.