Out of proportion PH in COPD: Report of a small case series
Bibliographic record
Abstract
Recent interest has focused on the subset of COPD patients with severe pulmonary hypertension despite a mild to moderate airflow obstruction, named out of proportion (OoP) PH in COPD. Despite a lack of specific guidelines, a general consensus on a cut off of mPAP≥ 40-45 mmHg has been reached. Here we describe a case series of 11 naïve patients screened at the center for PH and lung transplant of S. Matteo Hospital, from jan 2011 to dec 2012. Overall we screened with RHC 25 COPD patients on the basis of Echocardiographic signs of PH. Among them 8 had normal hemodynamics while 19 had mPAP >25 mmHg. 11 of these pts met the following criteria: previous diagnosis of COPD, emphysema at CT without fibrosis, mPAP≥ 40 mmHg, FEV1 > 50% of predicted, thus were defined OoP-PH in COPD. All of these patients were males (mean age70 ± 6) and characterized by: history of severe hypoxemia lasting >2ys, significant decrease of DLCO (mean 27 ± 10 %) with severely impaired exercise capacity (6MWT 187 ±142mt.), despite preserved lung volumes (mean FEV1 91 ±21%). At RHC all patients had pre-capillary PH (mean PCWP 11.2 ± 2.82 mmHg, mean mPAP 48.91 ± 5,6 mmHg) with reduced cardiac index (2.08 ± 0.44 l/min/m 2 ). 9/11 pts were submitted to compassionate treatment with sildenafil (+ inhaled Iloprost in 3), 1 was enrolled in a clinical trial and 1 had criteria for double lung transplant and was transplanted in 2 months. After 6 month treatment no significant change in hemodynamics was found. During treatment, 2 pts manifested signs of an associated collagen disease, 3 pts died after 0.5, 10 and 11 months follow-up. In conclusion OoP- PH in COPD is a rare but severe condition that is probably still underestimated and overlooked.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".