Dynamic hyperinflation is associated with a poor cardiovascular response to exercise in COPD patients

Respiratory Research

Alfredo Chetta²  Enrico Clini³  Dario Olivieri¹  Emilio Marangio¹  Luca Boracchia¹  Davide Elia¹  Marina Aiello¹  Panagiota Tzani² 

[1] Cardiopulmonary Dept, Respiratory Disease Unit, University Hospital (via Rasori 10), Parma (43125), Italy;Cardiopulmonary Dept, Lung Function Unit, University Hospital (via Rasori 10), Parma (43125), Italy;Department of Oncology, Haematology, Respiratory Diseases and Ospedale Villa Pineta, (Via Gaiato 127), Pavullo (MO) (41026), University of Modena-Reggio Emilia, Modena, Italy

关键词: COPD;    exercise;    cardiovascular response;    dynamic hyperinflation;   

Others  :  796772
DOI  :  10.1186/1465-9921-12-150

 received in 2011-07-19, accepted in 2011-11-10,  发布年份 2011

【 摘 要 】

Background

Pulmonary hyperinflation has the potential for significant adverse effects on cardiovascular function in COPD. The aim of this study was to investigate the relationship between dynamic hyperinflation and cardiovascular response to maximal exercise in COPD patients.

Methods

We studied 48 patients (16F; age 68 yrs ± 8; BMI 26 ± 4) with COPD. All patients performed spirometry, plethysmography, lung diffusion capacity for carbon monoxide (TLco) measurement, and symptom-limited cardiopulmonary exercise test (CPET). The end-expiratory lung volume (EELV) was evaluated during the CPET. Cardiovascular response was assessed by change during exercise in oxygen pulse (ΔO₂Pulse) and double product, i.e. the product of systolic blood pressure and heart rate (DP reserve), and by the oxygen uptake efficiency slope (OUES), i.e. the relation between oxygen uptake and ventilation.

Results

Patients with a peak exercise EELV (%TLC) ≥ 75% had a significantly lower resting FEV₁/VC, FEF₅₀/FIF₅₀ ratio and IC/TLC ratio, when compared to patients with a peak exercise EELV (%TLC) < 75%. Dynamic hyperinflation was strictly associated to a poor cardiovascular response to exercise: EELV (%TLC) showed a negative correlation with ΔO₂Pulse (r = - 0.476, p = 0.001), OUES (r = - 0.452, p = 0.001) and DP reserve (r = - 0.425, p = 0.004). Furthermore, according to the ROC curve method, ΔO₂Pulse and DP reserve cut-off points which maximized sensitivity and specificity, with respect to a EELV (% TLC) value ≥ 75% as a threshold value, were ≤ 5.5 mL/bpm (0.640 sensitivity and 0.696 specificity) and ≤ 10,000 Hg · bpm (0.720 sensitivity and 0.783 specificity), respectively.

Conclusion

The present study shows that COPD patients with dynamic hyperinflation have a poor cardiovascular response to exercise. This finding supports the view that in COPD patients, dynamic hyperinflation may affect exercise performance not only by affecting ventilation, but also cardiac function.

【 授权许可】

   
2011 Tzani et al; licensee BioMed Central Ltd.

【 图 表 】

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