Development of pulmonary hypertension (PH) in chronic lung diseases has both functional and prognostic implications .~PH in Lung diseases is usually mild to moderate with preserved cardiac output, and evolves slowly alongside the progression of lung disease and hypoxemia .~However, a minority of patients develop severe PH with elevations in pulmonary artery pressure that have been described as ''out of proportion'' to the underlying disease .~Hypotheses for the etiology of this phenotype include greater susceptibility to alveolar hypoxia and/or tobacco smoke , destruction of the capillary vascular bed , inflammatory factors initiating remodeling of the pulmonary vascular bed or the coexistence of idiopathic pulmonary arterial hypertension (IPAH) in patients with lung disease .~Severe PH-lung disease has been arbitrarily defined by a resting mean pulmonary artery pressure (PAP) ≥35 mmHg by RHC . The high and increasing prevalence of chronic lung diseases and the substantial consequences of developing severe PH have generated increasing interest in PH-lung diseases.~Pulmonary vascular research unit at Chest department at Kasr-Alani school of Medicine delivers regional, adult PH service to a population with a chronic lung disease.~The aim of this study is to compare the characteristics and outcomes of consecutive patients with PH-due to lung diseases diagnosed at our specialist referral center over a 1-year period.~Patients diagnosed as chronic lung diseases( COPD,ILD,OSA,Sarcoidosis) will be recruited from out-patient's clinics & inpatients wards of Internal medicine & Chest departments, Kasr Al-ainy hospital (from June 2016 to May 2015) A written informed consent matching with Helsinki declaration will be taken from all patients.~2.2 Study methods:~All the enrolled patients will go through the following basically:~Detailed standard Demographic & clinical parameters.~Assessment of exercise tolerance (6 MWD & WHO functional capacity)~Assessment of pulmonary function by PFTs.~ECG: (Right ventricular strain,Right axis deviation,Right bundle branch block,& Left side changes 0~Echocardiographic evaluation for PAH: ( Right atrial area ,Right ventricular area ,Tricuspid regurgitant jet velocity (TR) ,Tricuspid annular plane systolic excursion)~Radiography: including chest X-ray, HRCT chest, V/Q scan& CT angiography if needed~10. RT sided heart catheterization:~mPAP~PCWP~PVR~CARDIAC INDEX 11. Statistical analysis: ……..~The subjects will be classified according to RHC into either~Non PAH groups mPAP ≤ 21mmHG~PAH mPAP≥ 25 mmHG:~Severe PH-lung diseases mPAP ≥ 35 mmgh
Development of pulmonary hypertension (PH) in chronic lung diseases has both functional and prognostic implications .~PH in Lung diseases is usually mild to moderate with preserved cardiac output, and evolves slowly alongside the progression of lung disease and hypoxemia .~However, a minority of patients develop severe PH with elevations in pulmonary artery pressure that have been described as ''out of proportion'' to the underlying disease .~The aim of this study is to compare the characteristics and outcomes of consecutive patients with PH-due to lung diseases diagnosed at our specialist referral center over a 1-year period.