Pulmonary vasodilator therapy in COPD-associated pulmonary hypertension: A real-world case series of 14 patients confirmed by right heart catheterization.

Rationale: Pulmonary vasodilator therapy in chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) remains controversial, and real-world data describing which patients are selected for treatment after invasive hemodynamic confirmation are limited. We present a single-center case series of patients with RHC-confirmed COPD-PH treated with pulmonary vasodilators, focusing on clinical phenotype, hemodynamic profile, treatment patterns, and short-term outcomes. Methods: We conducted a retrospective case series of adults with COPD-associated PH identified by right heart catheterization (RHC) between 2018 and 2023. Patients with isolated precapillary PH or combined pre- and postcapillary PH treated with pulmonary vasodilators within 1 month of RHC were included. Outcomes included major adverse cardiovascular events (MACE), all-cause mortality, and pulmonary complications. Results: Among 200 patients with COPD-PH and a precapillary component, 14 patients (7%) received pulmonary vasodilator therapy after RHC and comprised the case series. Most had isolated precapillary PH (71%), severe PH by prior criteria (71%), and frequent cardiopulmonary comorbidities. Sildenafil monotherapy was used in 13/14 patients, while one received sildenafil plus macitentan. At 1-year follow-up, 5/13 patients with available data developed MACE, including 3 heart failure hospitalizations and 2 cardiovascular deaths. Among 4 patients with repeat RHC, 3 had higher PVR on follow-up evaluation. Conclusion: Pulmonary vasodilator therapy was used in a small, highly selected subset of patients with RHC-confirmed COPD-PH. Treated patients had heterogeneous hemodynamic profiles and frequent cardiovascular events during follow-up, supporting the need for careful phenotyping and prospective studies.