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. 2022 Dec 8;23(1):331.
doi: 10.1186/s12931-022-02238-9.

Abnormal pulmonary hemodynamics during exercise is associated with exercise capacity in COPD

Teresa Sassmann  1   2 , Philipp Douschan  1   2 , Vasile Foris  1   2 , Natascha Tröster  1 , Katarina Zeder  1   2 , Luka Brcic  3 , Adrienn Tornyos  4 , Gerhard Bachmaier  5 , Michael Fuchsjäger  4 , Horst Olschewski  1   2 , Gabor Kovacs  6   7
Affiliations

Abnormal pulmonary hemodynamics during exercise is associated with exercise capacity in COPD

Teresa Sassmann et al. Respir Res. .

Abstract

Background: Pulmonary hypertension (PH) is a frequent complication in COPD and it is associated with decreased exercise capacity and poor prognosis. We hypothesized that even in COPD patients without significant PH at rest, abnormal pulmonary hemodynamics during exercise affect exercise capacity.

Methods: Consecutive COPD patients with clinically indicated right heart catheterization and resting mean pulmonary arterial pressure (mPAP) < 25 mmHg and age- and sex-matched controls with the same limits of pulmonary hemodynamics but no chronic lung disease who underwent clinical work-up including invasive hemodynamic assessment during exercise, were retrospectively analyzed. Chi-square tests were used to evaluate differences between groups for categorical data and Fisher's exact test or Mann-Whitney-U-tests for continuous variables. Associations were analyzed with Spearman rank correlation tests.

Results: We included n = 26 COPD patients (female/male: 16/10, 66 ± 11 yr, FEV1: 56 ± 25%predicted) and n = 26 matched controls (FEV1: 96 ± 22%predicted). At rest, COPD patients presented with slightly increased mPAP (21 (18-23) vs. 17 (14-20) mmHg, p = 0.022), and pulmonary vascular resistance (PVR) [2.5 (1.9-3.0) vs. 1.9 (1.5-2.4) WU, p = 0.020] as compared to controls. During exercise, COPD patients reached significantly higher mPAP [47 (40-52) vs. 38 (32-44) mmHg, p = 0.015] and PVR [3.1 (2.2-3.7) vs. 1.7 (1.1-2.9) WU, p = 0.028] values despite lower peak exercise level [50 (50-75) vs. 100 (75-125) Watt, p = 0.002]. The mPAP/cardiac output slope was increased in COPD vs. controls [6.9 (5.5-10.9) vs. 3.7 (2.4-7.4) mmHg/L/min, p = 0.007] and negatively correlated with both peak oxygen uptake (r = - 0.46, p = 0.007) and 6-min walk distance (r = - 0.46, p = 0.001).

Conclusion: Even in the absence of significant PH at rest, COPD patients reveal characteristic abnormalities in pulmonary hemodynamics during exercise, which may represent an important exercise-limiting factor.

Keywords: COPD; Exercise capacity; Exercise hemodynamics; Right heart catheterization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the cohort
Fig. 2
Fig. 2
MPAP/CO slope; PAWP/CO slope and RAP/CO slope in COPD and controls. mPAP mean pulmonary artery pressure, PAWP pulmonary artery wedge pressure, RAP right atrial pressure, CO cardiac output
Fig. 3
Fig. 3
The relationship between cardiopulmonary exercise testing derived peak oxygen uptake (Peak VO2) and 6-min walk test (6MWT) with mean pulmonary arterial pressure/cardiac output slope (mPAP/CO slope (A, B), pulmonary vascular compliance (PVC) (C, D) and right ventricular output reserve (RVOR) (E, F). Red dots represent COPD patients, green dots controls
See this image and copyright information in PMC

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