الفهرس 
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Abstract
Chronic obstructive pulmonary disease (COPD) is defined as a heterogenous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production) due to abnormalities in airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive airflow obstruction. Pulmonary hypertension is a common complication of COPD that is generally mild to moderate but can be severe in some patients and has long been known to be associated with a reduced life expectancy in COPD, in proportion to increased PAP. PH was defined by echocardiography as systolic pulmonary artery pressure (sPAP) > 40 mm Hg. Echocardiography represents a non-invasive and reliable diagnostic tool in pulmonary hypertension with sensitivity (87%) and specificity (79%). In subjects with severe COPD right ventricular dysfunction has been shown to be one of the independent predictors of survival, together with impaired arterial oxygen partial pressure and pulmonary function. The 6MWD has been established as a significant marker of disease severity for COPD patients since it directly correlates with lower quality of life indices, respiratory and functional impairment, and survival. Moreover, a recent meta-analysis showed that exercise tolerance is significantly lower in patients with COPD and PH (COPD-PH) than in patients with COPD without PH (COPD-nonPH). The aim of this work was to assess six minutes walk test in chronic obstructive pulmonary disease (COPD) patients complicated with secondary pulmonary hypertension diagnosed by echocardiography. This comparative interventional study was carried out in Chest & Cardiology departments in Tanta University Hospitals on 87 attendants who were evaluated by history taking, clinical examination and pulmonary function tests then 30 subjects of them were chosen and echocardiography was done to them and they were classified into 3 groups; group I: 10 apparently healthy persons (5 males & 5 females with mean age 38.90 ± 4.53). group II: 10 COPD patients (7 males & 3 females with mean age 46.40 ± 4.65). group III: 10 COPD patients complicated with secondary pulmonary hypertension ( 6 males & 4 females with mean age 58.00 ± 4.37). Inclusion criteria: COPD Patients confirmed by clinical picture and pulmonary function tests with FEV1/FVC: 50% -70% without pulmonary hypertension (group II) and with pulmonary hypertension confirmed by echocardiography with systolic pulmonary arterial pressure (sPAP) >40mmHg (group III) with mean age above 18 years. Exclusion criteria: Other causes of pulmonary hypertension and Contraindications of 6 minutes walk test including; unstable angina and myocardial infarction during the previous month, pericarditis, myocarditis, heart failure, symptomatic arrhythmias, a resting heart rate of more than 120, a systolic blood pressure of more than 180 mm Hg, and a diastolic blood pressure of more than 100 mm Hg, bone and joints diseases. Summary of the results: Mean value of age in years was significantly increased in group III as compared to groups I & II and it was significantly increased in group II as compared to groups I. Sex was insignificantly different among the studied groups. Cough, expectoration, chest tightness, wheeze, chest pain, palpitation and fatigue were significantly different between three studied groups with. They were significantly higher in group III compared to group II and group I and higher in group II as compared to group I. Cyanosis was present in 40% of group III patients and wasn‟t present in group II and group I. Smoking was significantly different among the three studied groups. It was higher in group III as compared to group I & II and was higher in group II as compared to group I. Mean value of BMI in kg/m2 was insignificantly different among the three studied groups. Mean value of SaO2 by Pulse oximeter (%) was significantly lower in group III as compared to groups I & II and lower in group II as compared to groups I. Mean values of Systolic and diastolic blood pressure in mmHg were insignificantly different among three studied groups. Mean values of heart rate (beat/min) and Respiratory rate (cycle/min) were significantly increased in group III as compared to groups I & II and significantly increased in group II as compared to groups I. Mean value of mMRC score and CAT score were significantly higher in group III as compared to groups I & II and they were significantly higher in group II as compared to group I. Mean value of duration of disease was significantly higher in group III as compared to groups I & II and it was significantly higher in group II as compared to group I. Mean value of pH was insignificantly different among three groups. Mean values of PaO2 (mmHg) and oxygen saturation (SaO2) % were significantly lower in group III as compared to groups I & II and they were lower in group II as compared to group I. Mean values of PaCO2 (mmHg) and HCO3 (mEq\L) were significantly higher in group III as compared to groups I & II and they were significantly higher in group II as compared to group I. Mean values of FEV1 % of the predicted and FVC %, FEV1/FVC ratio, FEF25%-75% and PEFR of the predicted were significantly lower in group III as compared to groups II & I, and it were significantly lower in group II as compared to group I. Flattened diaphragm, lung hyperlucency and broncho-vascular markings were significantly different among three groups and they were higher in group III as compared to group II and higher in group II as compared to group I. Enlarged Pulmonary artery was present in 50% of group III patients and absent in group I and group II. Sinus rhythm was higher in group III as compared to groups I & II and was higher in group II as compared to group I. Right axis deviation (RAD) was present in 80% of group III patients and was not present in group I, II and P-pulmonale was present in 70% of group III patients and was not present in group I, II. Mean value of systolic Pulmonary artery pressure (sPAP) in mmHg was significantly increased in group III as compared to groups I & II and significantly increased in group II as compared to group I. Mean value of TAPSE in (cm) and Pulmonary acceleration time in (ms) were significantly lower in group III as compared to groups I & II and were significantly lower in group II as compared to group I. Mean values of Right ventricular (RV) diameter and Right atrial (RA) diameter in (cm) was significantly increased in group III as compared to groups I & II and were significantly increased in group II as compared to group I. Mean values of 6 minutes walk distance (6MWD) in (meter) significantly decreased in group III as compared to groups II & group I and it was significantly decreased in group II as compared to group I. In all patients, there was significant positive correlation between 6MWD and FEV1% of predicted, FEV1\FVC ratio%, FVC% of predicted, PEFR% of predicted, FEF25-75% of predicted, PaO2, SaO2 %, TAPSE and Pulmonary acceleration time. But there was insignificant positive correlation between 6MWD and pH. there was significant negative correlation between 6MWD and PaCO2, HCO3, sPAP, Right Ventricle (RV) basal diameter, Right atrial diameter (RA), mMRC score, CAT score, duration of disease and smoking. In all patients, there was significant positive correlation between mMRC score and PaCO2, HCO3, sPAP, Right Ventricle (RV) basal diameter and Right atrial diameter (RA). There was insignificant positive correlation between mMRC score and smoking. There was significant negative correlation between mMRC score and FEV1% of predicted, FEV1\FVC ratio, FVC% of predicted, PEFR% of predicted, FEF25-75% of predicted, PaO2, SaO2 %, TAPSE and Pulmonary acceleration time. There was insignificant negative correlation between mMRC score and pH. In all patients, there was significant negative correlation between CAT score and FEV1% of predicted, FEV1\FVC ratio, FVC% of predicted, PEFR% of predicted, FEF25-75% of predicted, PaO2, SaO2 %, TAPSE and Pulmonary acceleration time. There was insignificant negative correlation between CAT score and pH. There was significant positive correlation between CAT score and PaCO2, HCO3, sPAP, Right Ventricle (RV) basal diameter and Right atrial diameter (RA). There was insignificant positive correlation between CAT score and smoking.