Effect Of Pulmonary Hypertension On Exercise Tolerance In Patients With Copd: A Prognostic Systematic Review And Meta-Analysis

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 (W-max), -20.5 W (95% CI -34.4 to -6.5, p=0.004); and oxygen pulse (O-2 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); W-max, -26.6 W (95% CI -32.1 to -21.1 W, p<0.00001); and O-2 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.