Patterns of Oxygen Pulse Curve in Response to Incremental Exercise in Patients with Chronic Obstructive Pulmonary Disease – An Observational Study

Chuang, Ming Lung; Lin, I‐Feng; Huang, Shih Feng; Hsieh, Meng‐Jer

doi:10.1038/s41598-017-11189-x

Cited by 13 publications

(18 citation statements)

References 39 publications

(42 reference statements)

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“…IC peak /TLC <23% has also been associated with lower O 2P and exercise capacity in patients with severe COPD [27]. Although OUES was not measured in this study, our previous study reported that IC peak /TLC was significantly correlated with O 2P and ∆O 2P (r = 0.35-0.36, both p < 0.05) [28]. These results support an interaction between hyperinflation and decreased cardiac function that can contribute to exercise limitation in these patients.…”

Section: The % Of Tlcmentioning

confidence: 54%

Combining Dynamic Hyperinflation with Dead Space Volume during Maximal Exercise in Patients with Chronic Obstructive Pulmonary Disease

Chuang

2020

JCM

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Physiological dead space volume (V D ) and dynamic hyperinflation (DH) are two different types of abnormal pulmonary physiology. Although they both involve lung volume, their combination has never been advocated, and thus their effect and implication are unclear. This study aimed (1) to combine V D and DH, and (2) investigate their relationship and clinical significance during exercise, as well as (3) identify a noninvasive variable to represent the V D fraction of tidal volume (V D /V T ). Forty-six male subjects with chronic obstructive pulmonary disease (COPD) and 34 healthy male subjects matched for age and height were enrolled. Demographic data, lung function, and maximal exercise were investigated. End-expiratory lung volume (EELV) was measured for the control group and estimated for the study group using the formulae reported in our previous study. The V D /V T ratio was measured for the study group, and reference values of V D /V T were used for the control group. In the COPD group, the DH peak /total lung capacity (TLC, DH peak %) was 7% and the EELV peak % was 70%. After adding the V Dpeak % (8%), the V D DH peak % was 15% and the V D EELV peak % was 78%. Both were higher than those of the healthy controls. In the COPD group, the V D DH peak % and V D EELV peak % were more correlated with dyspnea score and exercise capacity than that of the DH peak % and EELV%, and had a similar strength of correlation with minute ventilation. The V Tpeak /TLC (V Tpeak %), an inverse marker of DH, was inversely correlated with V D /V T (R 2 ≈ 0.50). Therefore, we recommend that V D should be added to DH and EELV, as they are physiologically meaningful and V Tpeak % represents not only DH but also dead space ventilation. To obtain V D , the V D /V T must be measured. Because obtaining V D /V T requires invasive arterial blood gases, further studies on noninvasive predicting V D /V T is warranted.

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Section: The % Of Tlcmentioning

confidence: 54%

Combining Dynamic Hyperinflation with Dead Space Volume during Maximal Exercise in Patients with Chronic Obstructive Pulmonary Disease

Chuang

2020

JCM

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“…In addition, O 2 P curve pattern (O 2 PCP) is the trajectory of O 2 P during exercise, and therefore represents continuous monitoring of O 2 P. O 2 PCP is different in patients with obstructive airway disease and heart disease [ 7 ]. However, three types of O 2 PCP have been reported in patients with dyspnea [ 17 ] and COPD: plateau (P), decreasing (D), and increasing (I) types [ 18 ]. Furthermore, the P and D types are signs of cardiac dysfunction or myocardial ischemia in subjects with various heart diseases [ 17 , 19 , 20 ], and their presence should prompt additional cardiovascular work-up [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the P and D types are signs of cardiac dysfunction or myocardial ischemia in subjects with various heart diseases [ 17 , 19 , 20 ], and their presence should prompt additional cardiovascular work-up [ 19 , 20 ]. However, none of the O 2 PCP types are related to an ischemic heart in patients with COPD [ 18 ], and the relationships between O 2 PCP and ejection fraction in normal controls and in patients with COPD and chronic heart failure are unclear.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Oxygen Pulse and Its Curve Patterns on Male Patients with Heart Failure, Chronic Obstructive Pulmonary Disease, and Healthy Controls—Ejection Fractions, Related Factors and Outcomes

Chuang

Tsai

Ueng

et al. 2022

JPM

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Oxygen pulse (O2P) is a function of stroke volume and cellular oxygen extraction and O2P curve pattern (O2PCP) can provide continuous measurements of O2P. However, measurements of these two components are difficult during incremental maximum exercise. As cardiac function is evaluated using ejection fraction (EF) according to the guidelines and EF can be obtained using first-pass radionuclide ventriculography, the aim of this study was to investigate associations of O2P%predicted and O2PCP with EF in patients with heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) and chronic obstructive pulmonary disease (COPD), and also in normal controls. This was a prospective observational cross-sectional study. Correlations of resting left ventricular EF, dynamic right and left ventricular EFs and outcomes with O2P% and O2PCP across the three participant groups were analyzed. A total of 237 male subjects were screened and 90 were enrolled (27 with HFrEF/HFmrEF, 30 with COPD and 33 normal controls). O2P% and the proportions of the three types of O2PCP were similar across the three groups. O2P% reflected dynamic right and left ventricular EFs in the control and HFrEF/HFmrEF groups, but did not reflect resting left ventricular EF in all participants. O2PCP did not reflect resting or dynamic ventricular EFs in any of the subjects. A decrease in O2PCP was significantly related to nonfatal cardiac events in the HFrEF/HFmrEF group (log rank test, p = 0.01), whereas O2P% and O2PCP did not predict severe acute exacerbations of COPD. The findings of this study may clarify the utility of O2P and O2PCP, and may contribute to the currently used interpretation algorithm and the strategy for managing patients, especially those with HFrEF/HFmrEF. (Trial registration number NCT05189301.)

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“…Hence, heart rate % predicted and oxygen pulse at peak exercise were negatively correlated with V D /V Tpeak in the univariate and multivariate analyses (Table 3, r = À 0.46 and À0.63, P = .002 and <.0001, respectively; Table 2). Oxygen pulse at peak exercise [34] and its curve patterns [35] are influenced by both central cardiovascular function [36] and air trapping and dynamic hyperinflation in patients with chronic obstructive pulmonary disease. [34,35]…”

Section: Slow Vital Capacity and Heart Rate And Oxygen Pulse At Peak ...mentioning

confidence: 99%

Prediction and types of dead-space fraction during exercise in male chronic obstructive pulmonary disease patients

2022

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A high dead space (V D ) to tidal volume (V T ) ratio during peak exercise (V D /V Tpeak ) is a sensitive and consistent marker of gas exchange abnormalities; therefore, it is important in patients with chronic obstructive pulmonary disease (COPD). However, it is necessary to use invasive methods to obtain V D /V Tpeak , as noninvasive methods, such as end-tidal PCO 2 (P ET CO 2peak ) and P ET CO 2 adjusted with Jones' equation (P J CO 2peak ) at peak exercise, have been reported to be inconsistent with arterial PCO 2 at peak exercise (P a CO 2peak ). Hence, this study aimed to generate prediction equations for V D /V Tpeak using statistical techniques, and to use P ET CO 2peak and P J CO 2peak to calculate the corresponding V D /V Tpeak s (i.e., V D /V TpeakET V D /V TpeakJ ).A total of 46 male subjects diagnosed with COPD who underwent incremental cardiopulmonary exercise tests with P a CO 2 measured via arterial catheterization were enrolled. Demographic data, blood laboratory tests, functional daily activities, chest radiography, two-dimensional echocardiography, and lung function tests were assessed.In multivariate analysis, diffusing capacity, vital capacity, mean inspiratory tidal flow, heart rate, and oxygen pulse at peak exercise were selected with a predictive power of 0.74. There were no significant differences in the PCO 2peak values and the corresponding V D /V Tpeak values across the three types (both p = NS).In subjects with COPD, V D /V Tpeak can be estimated using statistical methods and the P ET CO 2peak and P J CO 2peak . These methods may have similar predictive power and thus can be used in clinical practice.

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Patterns of Oxygen Pulse Curve in Response to Incremental Exercise in Patients with Chronic Obstructive Pulmonary Disease – An Observational Study

Cited by 13 publications

References 39 publications

Combining Dynamic Hyperinflation with Dead Space Volume during Maximal Exercise in Patients with Chronic Obstructive Pulmonary Disease

Combining Dynamic Hyperinflation with Dead Space Volume during Maximal Exercise in Patients with Chronic Obstructive Pulmonary Disease

The Impact of Oxygen Pulse and Its Curve Patterns on Male Patients with Heart Failure, Chronic Obstructive Pulmonary Disease, and Healthy Controls—Ejection Fractions, Related Factors and Outcomes

Prediction and types of dead-space fraction during exercise in male chronic obstructive pulmonary disease patients

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