Aim

Evaluate the acute effects of non-invasive positive pressure ventilation (NiPPV) during high-intensity exercise on endothelial function in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF).

Methods

This is a randomized, double blinded, sham-controlled study involving 14 COPD-HF patients, who underwent a lung function test and Doppler echocardiography. On two different days, patients performed incremental cardiopulmonary exercise testing (CPET) and two constant-work rate tests (80% of CPET peak) receiving Sham or NiPPV (bilevel mode - Astral 150) in a random order until the limit of tolerance (Tlim). Endothelial function was evaluated by flow mediated vasodilation (FMD) at three time points: 1) Baseline; 2) immediately post-exercise with NiPPV; and 3) immediately post-exercise with Sham.

Results

Our patients had a mean age of 70 ± 7 years, FEV₁ 1.9 ± 0.7 L and LVEF 41 ± 9%. NIPPV resulted in an increased Tlim (NiPPV: 130 ± 29s vs Sham: 98 ± 29s p = 0.015) and SpO₂ (NiPPV: 94.7 ± 3.5% vs Sham: 92.7 ± 5.2% p = 0.03). Also, NiPPV was able to produce a significant increase in FMD (%) (NiPPV: 9.2 ± 3.1 vs Sham: 3.6 ± 0.7, p < 0.05), FMD (mm) (NiPPV: 0.41 ± 0.18 vs Sham: 0.20 ± 0.11, p < 0.05), Blood flow velocity (NiPPV: 33 ± 18 vs Baseline: 20 ± 14, p < 0.05) and Shear Stress (SS) (NiPPV: 72 ± 38 vs Baseline: 43 ± 25, p < 0.05). We found correlation between Tlim vs. ΔSS (p = 0.03; r = 0.57). Univariate-regression analysis revealed that increased SS influenced 32% of Tlim during exercise with NiPPV.

Conclusion

NiPPV applied during high-intensity exercise can acutely modulate endothelial function and improve exercise tolerance in COPD-HF patients. In addition, the increase of SS positively influences exercise tolerance.

中文翻译：

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高强度运动后COPD-HF患者的无创通气可改善运动耐力和外周血管功能

目标

评估高强度运动期间无创正压通气（NiPPV）对并存的慢性阻塞性肺疾病（COPD）和心力衰竭（HF）患者的内皮功能的急性影响。

方法

这是一项涉及14名COPD-HF患者的随机，双盲，假对照研究，他们接受了肺功能检查和多普勒超声心动图检查。在不同的两天，患者接受了随机的Sham或NiPPV（双水平模式-Astral 150）接受递增的心肺运动测试（CPET）和两次恒定工作率测试（CPET峰值的80％），直到耐受极限（Tlim ）。在三个时间点通过血流介导的血管舒张（FMD）评估内皮功能。2）立即用NiPPV进行运动后；3）立即与Sham进行运动后。

结果

我们的患者平均年龄为70±7岁，FEV ₁ 1.9±0.7 L，LVEF 41±9％。NIPPV导致Tlim（NiPPV：130±29s vs假：98±29s p = 0.015）和SpO ₂（NiPPV：94.7±3.5％vs Sham：92.7±5.2％p = 0.03）增加。此外，NiPPV能够显着提高FMD（％）（NiPPV：9.2±3.1 vs假：3.6±0.7，p <0.05），FMD（mm）（NiPPV：0.41±0.18 vs假：0.20±0.11， p <0.05），血流速度（NiPPV：33±18 vs基线：20±14，p <0.05）和剪切应力（SS）（NiPPV：72±38 vs基线：43±25，p <0.05）。我们发现Tlim与ΔSS之间具有相关性（p = 0.03; r = 0.57）。单变量回归分析显示，在NiPPV运动期间，SS的增加影响了Tlim的32％。

结论

高强度运动期间使用的NiPPV可以急性调节COPD-HF患者的内皮功能并提高运动耐力。此外，SS的增加对运动耐力有积极影响。