Chest
Volume 129, Issue 5, May 2006, Pages 1246-1252
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Original Research: Sarcoidosis
Incidence of Pulmonary Hypertension and Its Clinical Relevance in Patients With Sarcoidosis

https://doi.org/10.1378/chest.129.5.1246Get rights and content

Objective

To investigate the frequency of pulmonary hypertension (PH) and clinical parameters associated with PH in sarcoidosis patients.

Methods

A prospective, observational study was performed on 246 consecutive Japanese sarcoidosis patients followed up at the outpatient sarcoidosis clinic in the Central Clinic of Kyoto. The patients were evaluated for PH by Doppler echocardiography. Among these patients, 192 underwent pulmonary function tests. In addition, high-resolution CT of the lung was evaluated for the presence of lymph node enlargement, lung opacity, and thickening of bronchovascular bundles in 122 patients. PH was defined as estimated systolic pulmonary artery pressure (sPAP) ≥ 40 mm Hg. The frequency of PH was evaluated, and clinical parameters were compared between patients with PH and those without PH.

Results

Among 212 patients who were successfully evaluated for sPAP, 12 patients (5.7%) had PH. Patients with PH had the following clinical characteristics: advanced chest radiographic stage, decreased oxygen saturation, predominantly male gender, and decreased percentage of predicted vital capacity, percentage of predicted FVC, percentage of predicted FEV1, percentage of predicted functional residual capacity, and percentage of predicted total lung capacity (%TLC). Multivariate logistic regression analysis showed that decreased %TLC was independently associated with PH. There was a weak negative correlation between sPAP and %TLC (p < 0.05).

Conclusions

The frequency of PH in Japanese sarcoidosis patients was 5.7% evaluated with Doppler echocardiography. Decreased lung volume increases the risk of PH developing in patients with sarcoidosis.

Section snippets

Study Population

The study population comprised 246 Japanese sarcoidosis patients with histologic confirmation of the diagnosis. All patients were being consecutively followed up at the outpatient sarcoidosis clinic in the Central Clinic of Kyoto during the period between August 2004 and April 2005. Patients with concurrent collagen vascular diseases or other lung diseases were excluded from the study. The following procedures were performed in the study patients. DE was used to measure sPAP, and classification

Frequency of PH

Measurement of sPAP was possible by DE in 212 of 246 patients (86%). Tricuspid regurgitant flow was absent in the rest of the subjects. Among subjects with successful PAP measurement, 12 of 212 patients (5.7%) had sPAP ≥ 40 mm Hg, which fulfilled the definition of PH.

Association of Clinical Characteristics With PH

Comparison of clinical characteristics between subjects with PH and those without PH (Table 1) showed that male gender, advanced chest radiographic stage, and decreased Spo2 were associated with PH. Treatment history, usage of

Discussion

The epidemiology of PH in sarcoidosis has not been fully elucidated due to the difficulty in performing invasive assessment of PAP in substantial number of patients with various degrees of disease severity. We investigated the frequency of PH in sarcoidosis patients who were followed up in the outpatient clinic. Clinical parameters associated with PH were also investigated.

In this study, DE was used to estimate sPAP. Although some studies19, 20 have suggested that sPAP estimated by DE does not

Acknowledgment

We thank Mr. S. Ueda, Ms. M. Aoki, Ms. M. Koshimura, and Ms. K. Tanaka for performing the Doppler echocardiography.

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    This study was supported by a grant from the Smoking Research Foundation of Japan.

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