الفهرس 
COPDOnly 14 pages are availabe for public view
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Abstract
COPD is a common preventable and treatable disease, is characterized by persistent air-flow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and lung to noxious particles or gases Worldwide, the most commonly encountered risk factor for COPD is tobacco smoking.
Pulmonary hypertension (PH) is a progressive disorder characterized by abnormally el-evated blood pressure of the pulmonary circulation that results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance
Aim of Work:
Assess the role of Cardiac MRI in severe COPD patients with pulmonary artery pressure more than 35 mmHg as evaluated by Echocardiography and right sided cardiac catheterization .
Results:
(10) Among 20 COPD patients with PH, The mean age was 64.50 ± 7.94 with direct signif-icant correlation between the age and mPAP between group A (mPAP between 35 and 43.5 mmHg) and group B (mPAP between 43.5 and 101 mmHg). The study showed male predomi-nance with 18 male patients and 2 female patients.
(11) The studied 20 patients showed 9 patients with co-morbidities, 7 patients of them were in group B (mPAP between 43.5 and 101 mmHg), the co-morbidities included Morbid obesity, DVT , chronic kidney disease, hepatitis C virus and hyperlipidemia.
(12) HRCT showed 12 patients with emphysema only and 8 patients with combined em-physema and ILD syndrome. The patients with combined emphysema and ILD syn-drome were more in group B (mPAP between 43.5 and 101 mmHg).
(13) V/Q scan gave important results, with 4 positive CTEPH patients, all of them were in group B (mPAP between 43.5 and 101 mmHg). This show importance of considering other co-morbidities with higher mPAP.
(14) The echocardiography showed highly significant difference direct correlation along TRV, mPAP, RVSP and RA Diameter among both groups, which suggests the difference changes with higher mPAP measured by RHC.
(15) RHC parameters included RV pressure and PVR showed direct significant difference correlation between both studied groups, but CO showed indirect significant difference correlation among the studied 20 patients in both groups. Complications associated to RHC hap-pened in 8 patients more the patients with higher pressures, and included hypoxia, air embolism, arrhythmia and puncture of the carotid artery.
(16) Among cMRI changes in relation to mPAP measured by RHC, There were highly indirect significant correlation difference between both studied groups along with RVESV, RVEDV, RVSV and CO, while RA diameter changes when examined with cMRI shoed highly direct significant difference correlation among both groups. Those results showed the important role of cMRI measurements in assessment of the right side of the heart along with the diagnosis of PH by RHC.
(17) The mPAP measurement by Echo and RHC showed highly direct significant correla-tion difference, which suggest the high sensitivity of the RHC in the measurement mPAP and diagnosis of PH instead of echo which is not can be used only as a screening tool.
(18) There was also highly direct significant correlation difference in the meas-urement of RA diameter by Echo and cMRI, that also showed the accuracy of cMRI over echo in assessment of RA diameter. This result also improves that echo is only could be used as a screen-ing tool not for diagnosis or assessment of severity or prognosis of PH, while cMRI is useful in the assessment of the right side of the heart affected by PH by showing the morphological and functional changes due to PH over the right side of the heart.
Conclusion:
from the results of this work it could be concluded that:
chronic obstructive pulmonary disease is a frequent cause of pulmonary hypertension in the population of patients with chronic respiratory failure.
There is an overlap syndrome that presented by extensive RV remodeling than COPD alone.
Patients referral to a specialized center with PH-COPD have a poor prognosis that can be best predicted by age, functional status and markers of gas exchange and transport.
Echocardiography is a good predictive bed side tool for elevated PAP in high risk COPD patients. Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH.
Accurate estimation of pulmonary artery pressure in PH patients was not feasible by the MRI estimators studied. These noninvasive methods can not replace right heart catheteriza-tion at this moment, which is still the gold standard tool for diagnosis of PH. RHC still the best tool to detect pressures of the right side of the heart.
The proposed MRI protocol provides a comprehensive assessment of the effects of RV pressure overload in COPD patients before signs of heart failure have become manifest. Ear-ly recognition of RV pressure overload opens the prospect of early treatment and prevention of irreversible damage to the heart. Cardiac MRI can help to assess the severity of PH.
Recommendations:
from this work it is recommended that:
(8) Baseline evaluation of pulmonary hypertension in chronic obstructive pulmonary dis-ease patients is recommended.
(9) Health education of COPD patients on the manifestations that may suggest the presence of PH is mandatory.
(10) Echocardiography is the best noninvasive diagnostic tool for screening and early detec-tion of PH in COPD patients.
(11) Transferal of patients with COPDPH to specialized expert center with experienced operators for further assessment is mandatory.
(12) Right sided heart catheterization (RHC) is the gold standard tool recommended to be considered in patients with suspected PH in COPD patients to assist in differential diagnosis and to figure out other causes that may lead to PH.
(13) It’s recommended to highly recommended to do further studies on a wide scale of pop-ulation for a longer period of time to assess the condition of COPDPH.
(14) It’s recommended to use cardiac MRI in COPDPH to assess the right ventricular heart functions and morphological changes as a prognostic tool