What is the prognosis of cor pulmonale?

Updated: Dec 15, 2017
  • Author: Derek Leong, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Answer

Answer

The prognosis of cor pulmonale is variable depending upon the underlying pathology. Development of cor pulmonale as a result of a primary pulmonary disease usually heralds a poorer prognosis. For example, patients with chronic obstructive pulmonary disease (COPD) who develop cor pulmonale have a 30% chance of surviving 5 years. However, whether cor pulmonale carries an independent prognostic value or is simply reflecting the severity of underlying COPD or other pulmonary disease is not clear.

Prognosis in the acute setting due to massive pulmonary embolism or acute respiratory distress syndrome (ARDS) has not previously been shown to be dependent on the presence or absence of cor pulmonale. However, a prospective, multicenter cohort study by Volschan et al indicated that in cases of pulmonary embolism, cor pulmonale may be a predictor of inhospital mortality. [46] The authors collected demographic, comorbidity, and clinical manifestation data on 582 patients admitted to emergency or intensive care units and diagnosed with pulmonary embolism. Assessing the information using logistic regression analysis, the investigators built a prediction model. Their results indicated that in hemodynamically stable patients with pulmonary embolism, the following factors may be independent predictors of inhospital mortality [46] :

  • Age older than 65 years

  • Bed rest for longer than 72 hours

  • Chronic cor pulmonale

  • Sinus tachycardia

  • Tachypnea

A Chinese study indicated that chronic cor pulmonale is one of the major risk factors for early hospital readmission in patients following hospitalization for acute exacerbation of COPD. The study, by Lin et al, of 692 patients, included 63 patients who were readmitted to the hospital within 31 days after discharge. Through multivariate analysis, the investigators found that risk factors for early readmission included, in order of significance, chronic cor pulmonale (odds ratio [OR], 2.14), hypoproteinemia (OR, 2.02), and an elevated partial pressure of CO2 (Pa CO2 [OR, 1.03]). [47]


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