الفهرس 
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Abstract
COPD is a common preventable and treatable dis-ease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and lung to noxious particles or gases Worldwide, the most commonly encountered risk factor for COPD is to-bacco smoking.
Pulmonary hypertension (PH) is a progressive dis-order characterized by abnormally elevated blood pressure of the pulmonary circulation that results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance
The prevalence of pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) depends on the severity of the disease and the definition of PH. Several studies in patients with the previous GOLD (Global Initiative for chronic Obstructive Lung Disease) stage IV showed that up to 90% of these patients have a mean pulmonary artery pressure (mPAP) of>20mmHg,with most ranging between 20 and 35 mmHg and w3% to 5% patients with mPAP>35 to 40 mmHg.
Right heart catheterization is the most powerful maneuver for diagnosis confirmation by measuring the mean pres-sure of the pulmonary artery. It can also give more infor-mation about cardiac output and estimation of the pres-sure of the left atrium in order to assess the pressures of the left side of the heart by using pulmonary arterial wedge pressure.
Cardiac MRI is the preferred method for global analysis of ventricular structure function (e.g., volume, ejection fraction, wall motion abnormalities), myocardial mass, and myocardial viability.
The current study will include 20 COPD patients (FEV1 less than 50%) with Pulmonary Artery Pressure more than 35 mmHg. They will be collected from the out-patient clinic and department of chest specialized hospital KobryElkobba Armed Forces.
The following results were obtained:
(1) Among 20 COPD patients with PH, The mean age was 64.50 ± 7.94 with direct significant correlation be-tween the age and mPAP between group A (mPAP be-tween 35 and 43.5 mmHg) and group B (mPAP be-tween 43.5 and 101 mmHg). The study showed male predominance with 18 male patients and 2 female pa-tients.
(2) The studied 20 patients showed 9 patients with co-morbidities, 7 patients of them were in group B (mPAP between 43.5 and 101 mmHg), the co-morbidities included Morbid obesity, DVT , chronic kidney disease, hepatitis C virus and hyperlipidemia.
(3) HRCT showed 12 patients with emphysema only and 8 patients with combined emphysema and ILD syn-drome. The patients with combined emphysema and ILD syndrome were more in group B (mPAP between 43.5 and 101 mmHg).
(4) V/Q scan gave important results, with 4 positive CTEPH patients, all of them were in group B (mPAP between 43.5 and 101 mmHg). This show importance of considering other co-morbidities with higher mPAP.
(5) The echocardiography showed highly significant difference direct correlation along TRV, mPAP, RVSP and RA Diameter among both groups, which suggests the difference changes with higher mPAP measured by RHC.
(6) RHC parameters included RV pressure and PVR showed direct significant difference correlation be-tween both studied groups, but CO showed indirect significant difference correlation among the studied 20 patients in both groups. Complications as-sociated to RHC happened in 8 patients more the pa-tients with higher pressures, and included hypoxia, air embolism, arrhythmia and puncture of the carotid ar-tery.
(7) Among cMRI changes in relation to mPAP measured by RHC, There were highly indirect significant corre-lation difference between both studied groups along with RVESV, RVEDV, RVSV and CO, while RA di-ameter changes when examined with cMRI shoed highly direct significant difference correlation among both groups. Those results showed the important role of cMRI measurements in assessment of the right side of the heart along with the diagnosis of PH by RHC.
(8) The mPAP measurement by Echo and RHC showed highly direct significant correlation difference, which suggest the high sensitivity of the RHC in the meas-urement mPAP and diagnosis of PH instead of echo which is not can be used only as a screening tool.
(9) There was also highly direct significant correlation difference in the measurement of RA diameter by Echo and cMRI, that also showed the accuracy of cMRI over echo in assessment of RA diameter. This result also improves that echo is only could be used as a screening tool not for diagnosis or assessment of se-verity or prognosis of PH, while cMRI is useful in the assessment of the right side of the heart affected by PH by showing the morphological and functional changes due to PH over the right side of the heart.