Cardiovascular effects of exercise induced dynamic hyperinflation in COPD patients—Dynamically hyperinflated and non-hyperinflated subgroups

Abstract

Introduction An increase in respiratory rate and expiratory flow limitation can facilitate dynamic hyperinflation (DH), which may cause an element of the intrathoracic pressure in connection with the worsening of venous return, with negative effect on stroke volume (SV) and cardiac output (CO). It has been unclassified, whether poor circulatory adaptation to exercise can be attributed to DH or poor cardio-vascular performance itself in COPD. Only a subset of COPD patients exhibit dynamic hyperinflation during exercise. Patients and methods We designed a study to show how lung mechanical and cardiovascular parameters change in hyperinflated and non-hyperinflated COPD patients during exercise with a new experimental set-up. Thirty-three COPD patients with similar severity of COPD and left ventricular performance (20 men, 13 women, mean±SD age: 65,36±6,95 years) participated. We measured the cardiovascular parameters with a non-invasive device (Finometer-pro) including the left ventricular ejection time index (LVETi) and estimated the change of DH with inspiratory capacity (IC) manoeuvres during exercise. Results Twenty-one subjects exhibited DH (DH group) and 12 did not (non-DH group). The measurement results were given in mean ± SD and difference between the values measured during maximal load and rest also (ΔX = Xmax.load—Xrest). ΔSV and ΔCO were significantly higher in non-DH vs. DH patients (ΔSV: non-DH 9,7 ± 13,22 ml vs. DH -3,6 ± 14,34 ml, p = 0.0142; ΔCO: non-DH 2,26 ± 1,46 l/min vs. DH 0,88 ± 1,35 l/min, p = 0.0024). LVETi was not different between the two groups. Calculated oxygen delivery (DO2) during maximal load was significantly higher in non-DH group. Conclusion We concluded that worse cardiovascular adaptation to exercise of COPD patients can be associated with exercise-induced DH in a similar cardiovascular aged COPD group.

Prognostic Value of Pace Variability, a Novel 6MWT-Derived Feature, in Patients with Chronic Obstructive Pulmonary Disease

“…Since physiological studies have shown that during exercise, the use of supplemental oxygen can decrease minute ventilation and postpone the occurrence of dynamic hyperinflation, leading to a delay in the onset of dyspnea, which may enable higher exercise intensity, 25 a sensitivity analysis was conducted while excluding patients requiring oxygen supplement during the 6MWT.…”

Cardiovascular Diseases in COPD: From Diagnosis and Prevalence to Therapy

“…Additionally, due to increased lung volume and increased peripheral vascular resistance (PVR), which is a result of dynamic hyperinflation, the intrathoracic pressure increases during exhalation, decreasing the right ventricular (RV) preload and increasing the RV afterload [ 75 ]. Recent data from Lukacsovits et al has shown that the intrathoracic pressure during exercise in COPD patients has significantly greater swing than healthy individuals, thereby affecting stroke volume and cardiac output [ 76 ].…”