Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease

Abstract

Background: Local airway inflammation may cause systemic changes which result in endothelial dysfunction. Only a few studies have used reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with chronic obstructive pulmonary disease (COPD) in order to measure their endothelial dysfunction. Objective: To determine the efficacy of endothelial dysfunction, measured by RH-PAT, in assessing disease severity and systemic burden in a cohort of COPD patients. Methods: In this prospective, monocentric study, 157 patients with moderate to very severe COPD (GOLD class II-IV) were examined for endothelial dysfunction using RH-PAT (Itamar medical Ltd., Caesarea, Israel). In a nestedcohort, examination was repeated at exacerbation. The association between reactive hyperemia index (RHI), augmentation index (AI) and disease severity and outcome parameters was analysed. Results: 57% of the COPD patients had a dysfunctional endothelium and the median (IQR) RHI was 1.42 (1.27-1.53). Exacerbation of COPD was not associated with a significant change in RHI (p = 0.625) or ΑΙ (p = 0.530). None of the diagnostic or clinical outcomes of COPD was associated with RHI or arterial stiffness. Conclusion: Endothelial dysfunction is common in COPD. However, it does not seem to be a predictor neither of disease severity, nor of outcome and does not change during exacerbations of the disease.

Elevated Blood Pressure Occurs without Endothelial Dysfunction in a Rat Model of Pulmonary Emphysema

“…However, studies assessing invasive (acetylcholine-induced) or non-invasive (flow-mediated) vasorelaxation in COPD patients have not consistently demonstrated its impairment [ 52 , 53 ]. Moreover, using pulse-arterial tonometry, an impaired post-occlusive (endothelium-dependent) vasorelaxation was found in only 50 to 57% of patients [ 54 , 55 , 56 ], indicating that normal or even increased endothelium-dependent vasorelaxation may occur in at least 40% of COPD patients, in those with less severe pulmonary impairment [ 54 , 55 , 57 ]. Notably, some COPD patients with preserved exercise capacity and elevated BP have shown increased post-occlusive vasorelaxation [ 55 ], similar to our COPD-emphysema animal model.…”

“…Moreover, using pulse-arterial tonometry, an impaired post-occlusive (endothelium-dependent) vasorelaxation was found in only 50 to 57% of patients [ 54 , 55 , 56 ], indicating that normal or even increased endothelium-dependent vasorelaxation may occur in at least 40% of COPD patients, in those with less severe pulmonary impairment [ 54 , 55 , 57 ]. Notably, some COPD patients with preserved exercise capacity and elevated BP have shown increased post-occlusive vasorelaxation [ 55 ], similar to our COPD-emphysema animal model. Overall, our results challenge the notion that endothelial dysfunction, traditionally considered a preclinical vascular impairment in COPD, is a critical step leading to hypertension and cardiovascular comorbidities in COPD patients [ 58 , 59 , 60 ].…”

Endothelial dysfunction in COPD: a systematic review and meta-analysis of studies using different functional assessment methods

“…Despite the fact that all these techniques have boosted the research in this field, none of them has been established as a diagnostic tool for cardiovascular events prediction in daily clinical practice so far [ 15 ]. In COPD, FMD is the most widespread used functional method for peripheral endothelial function assessment, whereas in the recent years the application of PAT has gained more ground due to its noninvasive and operator-independent nature [ 16 ].…”