Details

Autor(en) / Beteiligte

• Boerrigter, Bart G., MD
• Bogaard, Harm J., MD, PhD
• Trip, Pia, MD
• Groepenhoff, Herman, MSc
• Rietema, Heleen, MD
• Holverda, Sebastiaan, PhD
• Boonstra, Anco, MD, PhD
• Postmus, Pieter E., MD, PhD, FCCP
• Westerhof, Nico, PhD
• Vonk-Noordegraaf, Anton, MD, PhD, FCCP

Titel

Ventilatory and Cardiocirculatory Exercise Profiles in COPD

Ist Teil von

• Chest, 2012-11, Vol.142 (5), p.1166-1174

Erscheinungsjahr

2012

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Background Pulmonary hypertension (PH) is a well-recognized complication of COPD. The impact of PH on exercise tolerance is largely unknown. We evaluated and compared the circulatory and ventilatory profiles during exercise in patients with COPD without PH, with moderate PH, and with severe PH. Methods Forty-seven patients, GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages II to IV, underwent cardiopulmonary exercise testing and right-sided heart catheterization at rest and during exercise. Patients were divided into three groups based on mean pulmonary artery pressure (mPAP) at rest: no PH (mPAP, < 25 mm Hg), moderate PH (mPAP, 25-39 mm Hg), and severe PH (mPAP, ≥ 40 mm Hg). Mixed venous oxygen saturation (S vo2 ) was used for evaluating the circulatory reserve. Pa co2 and the calculated breathing reserve were used for evaluation of the ventilatory reserve. Results Patients without PH (n = 24) had an end-exercise S vo2 of 48% ± 9%, an increasing Pa co2 with exercise, and a breathing reserve of 22% ± 20%. Patients with moderate PH (n = 14) had an exercise S vo2 of 40% ± 8%, an increasing Pa co2 , and a breathing reserve of 26% ± 15%. Patients with severe PH (n = 9) had a significantly lower end-exercise S vo2 (30% ± 6%), a breathing reserve of 37% ± 11%, and an absence of Pa co2 accumulation. Conclusion Patients with severe PH showed an exhausted circulatory reserve at the end of exercise. A profile of circulatory reserve in combination with ventilatory impairments was found in patients with COPD and moderate or no PH. The results suggest that pulmonary vasodilation might only improve exercise tolerance in patients with COPD and severe PH.