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Multicenter Study
. 2025 Sep 25;66(3):2500169.
doi: 10.1183/13993003.00169-2025. Print 2025 Sep.

Pulmonary pressure increases during acute exacerbation in COPD and clinical outcome

Ema Rastoder  1   2 , Pradeesh Sivapalan  1   3   2 , Caroline Hedsund  1 , Peter Kamstrup  1 , Tor Biering-Sørensen  4   5   6   7 , Maria Dons  4   5 , Trine Charlotte Bistrup Petersen  4   5 , Filip Soeskov Davidovski  4   5 , Kristoffer Grundtvig Skaarup  4   5 , Morten Sengeløv  4   5 , Emil Durukan  4   5 , Ditte Vesterlev  4   5 , Helena Zander Wodschow  8 , Lars Pedersen  9 , Josefin Eklöf  1 , Anna Kubel Vognsen  1 , Mia Moberg  10 , Julie Janner  10 , Louise Lindhardt Toennesen  10 , Hashmat S Z Bahrami  11   12 , Ulrik Dixen  11 , Jens Dahlgaard Hove  11 , Magnus Thorsten Jensen  7 , Daniel Alexander Ackermann  1 , Alexander Jordan  1 , Valdemar Rømer  1 , Søren Sperling  13 , Elisabeth Bendstrup  13   14 , Casper Falster  15   16 , Christian B Laursen  15   16 , Jørn Carlsen  3   6 , Jens-Ulrik Stæhr Jensen  17   3
Affiliations
Multicenter Study

Pulmonary pressure increases during acute exacerbation in COPD and clinical outcome

Ema Rastoder et al. Eur Respir J. .

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

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Conflict of interest statement

Conflict of interest: T. Biering-Sørensen reports grants from Sanofi Pasteur and GE Healthcare, payment or honoraria for lectures, presentations, manuscript writing or educational events from Novartis and Sanofi Pasteur, participation on a data safety monitoring board or advisory board with Sanofi Pasteur and Amgen, and a leadership role on the steering committee of the Amgen-financed GALACTIC-HF trial. E. Bendstrup reports fees and grants from Boehringer Ingelheim, Hoffman-La Roche, Galapagos and Bristol Myers Squibb. C.B. Laursen reports payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Chiesi and GSK, and royalties or licences from Munksgaard. J. Carlsen is a member of an advisory board for Merck and has received institutional research grants and institutional speaker fees. The remaining authors have no potential conflicts of interest to disclose.

Figures

None
Overview of the study. AECOPD: acute exacerbation in COPD; TR: tricuspid regurgitation; TAPSE: tricuspid annular plane systolic excursion.
FIGURE 1
FIGURE 1
Patient flowchart. AECOPD: acute exacerbation in COPD; TTE: transthoracic echocardiography; TR: tricuspid regurgitation.
FIGURE 2
FIGURE 2
Box plot of tricuspid regurgitation (TR) gradient during hospitalisation with exacerbation and at follow-up in the stable phase, 30 days after hospital discharge, showing median and interquartile range.
FIGURE 3
FIGURE 3
Box plot of tricuspid regurgitation (TR) gradient stratified according to quartiles of days alive and out of hospital (DAOH), showing median and interquartile range. First quartile: 0–19 days, fourth quartile: 26–29 days; p=0.0394 (Kruskal–Wallis test).
See this image and copyright information in PMC

Comment in

References

    1. Oudijk EJD, Lammers JWJ, Koenderman L. Systemic inflammation in chronic obstructive pulmonary disease. Eur Respir J 2003; 22: Suppl. 46, 5s–13s. doi: 10.1183/09031936.03.00004603a - DOI - PubMed
    1. Labaki WW, Rosenberg SR. Chronic obstructive pulmonary disease. Ann Intern Med 2020; 173: ITC17–ITC32. doi: 10.7326/AITC202008040 - DOI - PubMed
    1. World Health Organization . Chronic obstructive pulmonary disease (COPD). 2023. www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-d... Date last accessed: 22 June 2025.
    1. Weitzenblum E. Chronic cor pulmonale. Heart 2003; 89: 225–230. doi: 10.1136/heart.89.2.225 - DOI - PMC - PubMed
    1. Chaouat A, Naeije R, Weitzenblum E. Pulmonary hypertension in COPD. Eur Respir J 2008; 32: 1371–1385. doi: 10.1183/09031936.00015608 - DOI - PubMed

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