Correlation of cardiopulmonary exercise testing parameters with quality of life in stable COPD patients

Abstract

Background: The precise head to head relationships between Cardio-pulmonary exercise testing (CPET) parameters and patients' daily symptoms/activities and the disease social/emotional impact are less well defined. In this study, the correlation of COPD daily symptoms and quality of life [assessed by St. George's Respiratory Questionnaire (SGRQ)] and COPD severity index (BODE-index) with CPET parameters were investigated. Methods: Symptom-limited CPET was performed in 37 consecutive COPD (GOLD I-III) subjects during non-exacerbation phase. The SGRQ was also completed by each patient. Results: SGRQ-score correlated negatively with FEV1 (r=−0.49, P<0.01), predicted maximal workrate (%WR-max) (r=−0.44, P<0.01), V'O 2 /WR (r=−0.52, P<0.01) and breathing reserve (r=−0.50, P<0.01). However it did not correlate with Peak-V'O 2 % predicted (r=−0.27, P=0.10). In 20 (54.1%) subjects in which leg fatigue was the main cause for stopping the test, Peak-V'O 2 , %WR-max, HR-Reserve and Breathing reserve were higher (P=0.04, <0.01, 0.04 and <0.01 respectively) than the others. There was also a significant correlation between BODE-index and ∆VO 2 /∆WR (r=−0.64, P<0.001) and breathing-reserve (r=−0.38, P=0.018). Conclusions: The observed relationships between CPET parameter and daily subjective complaints in COPD were not strong. Those who discontinued the CPET because of leg fatigue were in the earlier stages of COPD. Significant negative correlation between ∆VO 2 /∆WR and BODE-index suggests that along with COPD progression, regardless of negative past history, other comorbidities such as cardiac/musculoskeletal problems should be sought. Although more difficult to use than other tools such as COPD Assessment Test (CAT) or COPD Clinical Questionnaire (CCQ) during routine daily practice (6), the St. George's Respiratory Questionnaire (SGRQ) is one of the most widely used self-complete measures in research for assessing patients' symptoms, activities and quality of life (7,8). Along with this subjective measurement, functional capacity in COPD could be measured by objective tools such as cardio-pulmonary exercise testing (CPET) or 6-min walk distance (6MWD) (9-11). Considering the fact that at rest physiologic variable such as pulmonary diffusing capacity for carbon monoxide (DLCO), body mass index (BMI) or even forced expiratory volume in one second (FEV1) could not solely predict exercise intolerance, CPET has been proposed as the gold standard for evaluating the exercise intolerance in patients with pulmonary diseases, including COPD (12). But the precise head to head comparisons of CPET variable with patients' daily symptoms/activities and the disease social/ emotional impact are less well defined. In one study among 129 COPD subjects with GOLD stage II and III, there was at best a weak correlation between Peak-V'O 2 (maximum oxygen uptake) % predicted and some sub-domains of health status (13). While in another study Peak-V'O 2 was to some extent a predictor of physical function (r 2 increased by 0.109) and health-related ...

Early-Phase Recovery of Cardiorespiratory Measurements after Maximal Cardiopulmonary Exercise Testing in Patients with Chronic Obstructive Pulmonary Disease

“…, value ≤ 30%) is commonly used in the literature [4, 30, 31], but it remains wide, and it may not be adapted for all individuals. Indeed, recently Mirdamadi et al [32] have reported a mean ventilatory reserve = 30.9% (which is according to our study), but their study revealed also wide standard deviation (±25.1%). More specifically, their results showed a ventilatory reserve = 43.1 ± 25.6% in patients with leg fatigue and only a ventilatory reserve = 16.6 ± 15.4 in patients without leg fatigue [32].…”

“…Indeed, recently Mirdamadi et al [32] have reported a mean ventilatory reserve = 30.9% (which is according to our study), but their study revealed also wide standard deviation (±25.1%). More specifically, their results showed a ventilatory reserve = 43.1 ± 25.6% in patients with leg fatigue and only a ventilatory reserve = 16.6 ± 15.4 in patients without leg fatigue [32]. Consequently, it is possible that in the current study we have considered that CPET was maximal from ventilatory reserve ≤ 30% in COPD patients without leg fatigue, while a low ventilatory reserve should have been researched (approximately ≤ 15% in these patients).…”

Nitrogen single-breath washout test for evaluating exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease

“…Our findings were similar to those of Morishita-Katsu et al ( 36 ) who evaluated 109 subjects with stable COPD and observed a weak correlation between the SGRQ score and clinical and functional variables at rest. Regarding exercise, Mirdamadi et al ( 38 ) evaluated 37 patients with COPD (GOLD I-III) and found no significant correlation between peak VO 2 and the SGRQ score. Similarly, other researchers reported that peak VO 2 is a poor indicator of health status ( 3 , 39 ), suggesting that CPET parameters at peak exercise may not be effective for evaluating the ADLs of patients.…”

The impact of chronic obstructive pulmonary disease and hypertension on the development and progression of atrial fibrillation

“…Любые структурные заболевания сердечнососудистой системы (ССС), такие как АГ, ХСН, ишемическая болезнь сердца (ИБС) могут способствовать медленной, но неуклонно прогрессирующей структурной перестройке желудочков и предсердий, этот процесс происходит в связи с пролиферацией и заменой фибробластов на миофибробласты, а также усиленным отложением соединительной ткани и фиброзом [7]. По мере накопления знаний о патогенезе ФП, и, в первую очередь, о вкладе сопутствующих заболеваний в течение этого процесса, становится сомнительным существование первичной или идиопатической ФП [8]. В сравнительно недавнем масштабном исследовании European Heart Survey, участниками которого стали 3978 пациентов с ФП, частота идиопатического или первичного типа данной патологии наблюдалась всего лишь у 3% из выше указанного числа лиц, принимавших участие [9].…”