Chest
Original ResearchPulmonary Vascular DiseaseVentilatory and Cardiocirculatory Exercise Profiles in COPD: The Role of Pulmonary Hypertension
Section snippets
Patients
Subjects were either recruited from the local outpatient clinic or referred by other hospitals for the evaluation of PH. Subjects were diagnosed with moderate to very severe COPD according to American Thoracic Society/European Respiratory Society criteria.15 Exclusion criteria were (1) a history of left-sided cardiac failure, (2) left ventricular dysfunction and/or valvular disease on Doppler echocardiography, (3) atrial fibrillation, (4) neuromuscular disorders, or (5) an acute exacerbation of
Study Population
Forty-seven patients with COPD (25 men, 22 women; mean age, 65 y) were included. Twenty-four patients had no PH, 14 patients had moderate PH, and nine patients had severe PH. Demographic data, pulmonary function, and resting hemodynamics are summarized in Table 1.
Incremental Cardiopulmonary Exercise Test
The characteristics of the three groups are presented in Table 2 and Figure 1. The subjects had a severe impaired exercise capacity, as evidenced by peak work rates and o2s that were, on average, < 50% predicted and < 15 mL/kg/min,
Discussion
In this study, we used CPET data combined with invasive hemodynamic measurements at rest and during maximal exercise to evaluate whether PH contributes to exercise intolerance in COPD. Only in patients with COPD and severe PH did the Svo2 at end-exercise decrease to a level usually found in healthy subjects,27, 28 which is consistent with reaching a circulatory limitation. From this, together with the finding of a low CO/o2 slope, we can conclude that these patients had exhausted their
Conclusions
The current study shows a PH-induced circulatory limitation to exercise in patients with COPD and an mPAP of ≥ 40 mm Hg. In patients with COPD without or with moderate PH, the exercise profile indicates a circulatory reserve and a predominantly ventilatory limitation to exercise.
Acknowledgments
Author contributions: Dr Vonk-Noordegraaf serves as guarantor and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Boerrigter: contributed to the concept and design of the study, acquisition of data, analysis or interpretation of data, drafting of the manuscript, and final approval of the version of the manuscript to be published.
Dr Bogaard: contributed to the analysis or interpretation of data, drafting of the manuscript, and final approval of the
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Funding/Support: Dr Vonk-Noordegraaf was supported by the Netherlands Organisation for Scientific Research-VIDI [Project No. 917.96.306].
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