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Neder JA, Rocha A, Arbex FF, Alencar MCN, Sperandio PA, Hirai DM, Berton DC. Exertional oscillatory ventilation in subjects without heart failure reporting chronic dyspnoea. ERJ Open Res 2023; 9:00324-2022. [PMID: 36726368 PMCID: PMC9885272 DOI: 10.1183/23120541.00324-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
Oscillatory ventilation detected on incremental cardiopulmonary exercise testing might be found in subjects without heart failure reporting exertional dyspnoea despite the best available therapy for their underlying cardiopulmonary disease https://bit.ly/3Tyl7bE.
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Affiliation(s)
- J. Alberto Neder
- Laboratory of Clinical Exercise Physiology (LACEP) and Respiratory Investigation Unit (RIU), Queen's University and Kingston General Hospital, Kingston, ON, Canada,J. Alberto Neder ()
| | - Alcides Rocha
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Flavio F. Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Clara N. Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila A. Sperandio
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel M. Hirai
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Danilo C. Berton
- Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Mazzuco A, Souza AS, Medeiros WM, Sperandio PA, Alencar MCN, Arbex FF, Neder JA, Borghi-Silva A. Effects of high- and moderate-intensity exercise on central hemodynamic and oxygen uptake recovery kinetics in CHF-COPD overlap. ACTA ACUST UNITED AC 2020; 53:e9391. [PMID: 32077467 PMCID: PMC7025454 DOI: 10.1590/1414-431x20199391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
Abstract
The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.
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Affiliation(s)
- A Mazzuco
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A S Souza
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - W M Medeiros
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - P A Sperandio
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - M C N Alencar
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - F F Arbex
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - J A Neder
- Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - A Borghi-Silva
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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Rocha A, Arbex FF, Sperandio PA, Mancuso F, Marillier M, Bernard AC, Alencar MCN, O'Donnell DE, Neder JA. Exercise intolerance in comorbid COPD and heart failure: the role of impaired aerobic function. Eur Respir J 2019; 53:13993003.02386-2018. [PMID: 30765506 DOI: 10.1183/13993003.02386-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/22/2019] [Indexed: 12/28/2022]
Abstract
Impaired aerobic function is a potential mechanism of exercise intolerance in patients with combined cardiorespiratory disease. We investigated the pathophysiological and sensory consequences of a low change in oxygen uptake (ΔV'O2 )/change in work rate (ΔWR) relationship during incremental exercise in patients with coexisting chronic obstructive pulmonary disease (COPD) and systolic heart failure (HF).After clinical stabilisation, 51 COPD-HF patients performed an incremental cardiopulmonary exercise test to symptom limitation. Cardiac output was non-invasively measured (impedance cardiography) in a subset of patients (n=18).27 patients presented with ΔV'O2 /ΔWR below the lower limit of normal. Despite similar forced expiratory volume in 1 s and ejection fraction, the low ΔV'O2 /ΔWR group showed higher end-diastolic volume, lower inspiratory capacity and lower transfer factor compared to their counterparts (p<0.05). Peak WR and peak V'O2 were ∼15% and ∼30% lower, respectively, in the former group: those findings were associated with greater symptom burden in daily life and at a given exercise intensity (leg discomfort and dyspnoea). The low ΔV'O2 /ΔWR group presented with other evidences of impaired aerobic function (sluggish V'O2 kinetics, earlier anaerobic threshold) and cardiocirculatory performance (lower oxygen pulse, lower stroke volume and cardiac output) (p<0.05). Despite similar exertional hypoxaemia, they showed worse ventilatory inefficiency and higher operating lung volumes, which led to greater mechanical inspiratory constraints (p<0.05).Impaired aerobic function due to negative cardiopulmonary-muscular interactions is an important determinant of exercise intolerance in patients with COPD-HF. Treatment strategies to improve oxygen delivery to and/or utilisation by the peripheral muscles might prove particularly beneficial to these patients.
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Affiliation(s)
- Alcides Rocha
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Flavio F Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila A Sperandio
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Frederico Mancuso
- Division of Cardiology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Mathieu Marillier
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Anne-Catherine Bernard
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Maria Clara N Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, ON, Canada
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Aranda L, Ribeiro IC, Degani‐Costa LH, Arbex FF, Schoorlemmer H, Vianna LC, Nery LE, Silva BM. Muscle Mechanoreflex Control of Ventilation and Inspiratory Drive in Patients with Chronic Obstructive Pulmonary Disease. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.547.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Luiz E Nery
- Federal University of Sao PauloSao PauloBrazil
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Rocha A, Arbex FF, Sperandio PA, Souza A, Biazzim L, Mancuso F, Berton DC, Hochhegger B, Alencar MCN, Nery LE, O'Donnell DE, Neder JA. Excess Ventilation in Chronic Obstructive Pulmonary Disease-Heart Failure Overlap. Implications for Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2017; 196:1264-1274. [PMID: 28665692 DOI: 10.1164/rccm.201704-0675oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE An increased ventilatory response to exertional metabolic demand (high [Formula: see text]e/[Formula: see text]co2 relationship) is a common finding in patients with coexistent chronic obstructive pulmonary disease and heart failure. OBJECTIVES We aimed to determine the mechanisms underlying high [Formula: see text]e/[Formula: see text]co2 and its impact on operating lung volumes, dyspnea, and exercise tolerance in these patients. METHODS Twenty-two ex-smokers with combined chronic obstructive pulmonary disease and heart failure with reduced left ventricular ejection fraction undertook, after careful treatment optimization, a progressive cycle exercise test with capillary (c) blood gas collection. MEASUREMENTS AND MAIN RESULTS Regardless of the chosen metric (increased [Formula: see text]e-[Formula: see text]co2 slope, [Formula: see text]e/[Formula: see text]co2 nadir, or end-exercise [Formula: see text]e/[Formula: see text]co2), ventilatory inefficiency was closely related to PcCO2 (r values from -0.80 to -0.84; P < 0.001) but not dead space/tidal volume ratio. Ten patients consistently maintained exercise PcCO2 less than or equal to 35 mm Hg (hypocapnia). These patients had particularly poor ventilatory efficiency compared with patients without hypocapnia (P < 0.05). Despite the lack of between-group differences in spirometry, lung volumes, and left ventricular ejection fraction, patients with hypocapnia had lower resting PaCO2 and lung diffusing capacity (P < 0.01). Excessive ventilatory response in this group was associated with higher exertional PcO2. The group with hypocapnia, however, had worse mechanical inspiratory constraints and higher dyspnea scores for a given work rate leading to poorer exercise tolerance compared with their counterparts (P < 0.05). CONCLUSIONS Heightened neural drive promoting a ventilatory response beyond that required to overcome an increased "wasted" ventilation led to hypocapnia and poor exercise ventilatory efficiency in chronic obstructive pulmonary disease-heart failure overlap. Excessive ventilation led to better arterial oxygenation but at the expense of earlier critical mechanical constraints and intolerable dyspnea.
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Affiliation(s)
- Alcides Rocha
- 1 Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respirology, and
| | - Flavio F Arbex
- 1 Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respirology, and
| | - Priscilla A Sperandio
- 1 Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respirology, and
| | - Aline Souza
- 1 Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respirology, and
| | - Ligia Biazzim
- 1 Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respirology, and
| | - Frederico Mancuso
- 2 Division of Cardiology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Danilo C Berton
- 3 Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- 4 Medical Imaging Research Laboratory, Federal University of Health Sciences, Porto Alegre, Brazil; and
| | - Maria Clara N Alencar
- 1 Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respirology, and
| | - Luiz E Nery
- 1 Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respirology, and
| | - Denis E O'Donnell
- 5 Respiratory Investigation Unit, Queen's University, Kingston, Ontario, Canada
| | - J Alberto Neder
- 5 Respiratory Investigation Unit, Queen's University, Kingston, Ontario, Canada
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Neder JA, Berton DC, Arbex FF, Alencar MC, Rocha A, Sperandio PA, Palange P, O'Donnell DE. Physiological and clinical relevance of exercise ventilatory efficiency in COPD. Eur Respir J 2017; 49:49/3/1602036. [PMID: 28275174 DOI: 10.1183/13993003.02036-2016] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/12/2016] [Indexed: 01/09/2023]
Abstract
Exercise ventilation (V'E) relative to carbon dioxide output (V'CO2 ) is particularly relevant to patients limited by the respiratory system, e.g. those with chronic obstructive pulmonary disease (COPD). High V'E-V'CO2 (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV1). Establishing an association between high V'E-V'CO2 and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV1 impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase V'E-V'CO2 In fact, a high V'E-V'CO2 has been found to be a powerful predictor of poor outcome in lung resection surgery. Moreover, a high V'E-V'CO2 has added value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of COPD severity. Documenting improved ventilatory efficiency after lung transplantation and lung volume reduction surgery provides objective evidence of treatment efficacy. Considering the usefulness of exercise ventilatory efficiency in different clinical scenarios, the V'E-V'CO2 relationship should be valued in the interpretation of cardiopulmonary exercise tests in patients with mild-to-end-stage COPD.
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Affiliation(s)
- J Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Danilo C Berton
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada.,Division of Respiratory Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flavio F Arbex
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Clara Alencar
- Division of Cardiology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alcides Rocha
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila A Sperandio
- Pulmonary Function and Clinical Exercise Physiology, Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paolo Palange
- Dept of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Denis E O'Donnell
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
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Rocha A, Arbex FF, Alencar MCN, Sperandio PA, Hirai DM, Berton DC, O'Donnell DE, Neder JA. Physiological and sensory consequences of exercise oscillatory ventilation in heart failure-COPD. Int J Cardiol 2016; 224:447-453. [DOI: 10.1016/j.ijcard.2016.09.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 12/31/2022]
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Arbex FF, Alencar MC, Souza A, Mazzuco A, Sperandio PA, Rocha A, Hirai DM, Mancuso F, Berton DC, Borghi-Silva A, Almeida DR, O'Donnell DE, Neder JA. Exercise Ventilation in COPD: Influence of Systolic Heart Failure. COPD 2016; 13:693-699. [DOI: 10.1080/15412555.2016.1174985] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Flavio F. Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Clara Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Aline Souza
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Adriana Mazzuco
- Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Priscila A. Sperandio
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Alcides Rocha
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel M. Hirai
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, Canada
| | - Frederico Mancuso
- Division of Cardiology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Danilo C. Berton
- Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Audrey Borghi-Silva
- Department of Physiotherapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Dirceu R. Almeida
- Division of Cardiology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Denis E. O'Donnell
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, Canada
| | - J. Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respirology, Federal University of Sao Paulo, Sao Paulo, Brazil
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Queen's University and Kingston General Hospital, Kingston, Canada
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Neder JA, Alharbi A, Berton DC, Alencar MCN, Arbex FF, Hirai DM, Webb KA, O'Donnell DE. Exercise Ventilatory Inefficiency Adds to Lung Function in Predicting Mortality in COPD. COPD 2016; 13:416-24. [DOI: 10.3109/15412555.2016.1158801] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Neder JA, Ramos RP, Ota-Arakaki JS, Ferreira EMV, Hirai DM, Sperandio PA, Alencar MCN, Arbex FF, Berton DC, D'Arsigny C, O'Donnell DE. Insights into ventilation-gas exchange coupling in chronic thromboembolic pulmonary hypertension. Eur Respir J 2016; 48:252-4. [PMID: 27076589 DOI: 10.1183/13993003.01948-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/28/2016] [Indexed: 11/05/2022]
Affiliation(s)
- J Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Roberta P Ramos
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil Pulmonary Vascular Group, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jaquelina S Ota-Arakaki
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil Pulmonary Vascular Group, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Eloara M V Ferreira
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil Pulmonary Vascular Group, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Daniel M Hirai
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Priscila A Sperandio
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Clara N Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Flavio F Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit, Respiratory Division, Dept of Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Danilo C Berton
- Respiratory Division, Dept of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christine D'Arsigny
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Dept of Medicine, Queen's University, Kingston, ON, Canada
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Oliveira MF, Arbex FF, Alencar MC, Souza A, Sperandio PA, Medeiros WM, Mazzuco A, Borghi-Silva A, Medina LA, Santos R, Hirai DM, Mancuso F, Almeida D, O'Donnell DE, Neder JA. Heart Failure Impairs Muscle Blood Flow and Endurance Exercise Tolerance in COPD. COPD 2016; 13:407-15. [PMID: 26790095 DOI: 10.3109/15412555.2015.1117435] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Heart failure, a prevalent and disabling co-morbidity of COPD, may impair cardiac output and muscle blood flow thereby contributing to exercise intolerance. To investigate the role of impaired central and peripheral hemodynamics in limiting exercise tolerance in COPD-heart failure overlap, cycle ergometer exercise tests at 20% and 80% peak work rate were performed by overlap (FEV1 = 56.9 ± 15.9% predicted, ejection fraction = 32.5 ± 6.9%; N = 16), FEV1-matched COPD (N = 16), ejection fraction-matched heart failure patients (N = 15) and controls (N = 12). Differences (Δ) in cardiac output (impedance cardiography) and vastus lateralis blood flow (indocyanine green) and deoxygenation (near-infrared spectroscopy) between work rates were expressed relative to concurrent changes in muscle metabolic demands (ΔO2 uptake). Overlap patients had approximately 30% lower endurance exercise tolerance than COPD and heart failure (p < 0.05). ΔBlood flow was closely proportional to Δcardiac output in all groups (r = 0.89-0.98; p < 0.01). Overlap showed the largest impairments in Δcardiac output/ΔO2 uptake and Δblood flow/ΔO2 uptake (p < 0.05). Systemic arterial oxygenation, however, was preserved in overlap compared to COPD. Blunted limb perfusion was related to greater muscle deoxygenation and lactate concentration in overlap (r = 0.78 and r = 0.73, respectively; p < 0.05). ΔBlood flow/ΔO2 uptake was related to time to exercise intolerance only in overlap and heart failure (p < 0.01). In conclusion, COPD and heart failure add to decrease exercising cardiac output and skeletal muscle perfusion to a greater extent than that expected by heart failure alone. Treatment strategies that increase muscle O2 delivery and/or decrease O2 demand may be particularly helpful to improve exercise tolerance in COPD patients presenting heart failure as co-morbidity.
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Affiliation(s)
- Mayron F Oliveira
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Flavio F Arbex
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Maria Clara Alencar
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Aline Souza
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Priscila A Sperandio
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Wladimir M Medeiros
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Adriana Mazzuco
- b Department of Physiotherapy , Federal University of São Carlos (UFSCAR) , São Carlos , Brazil
| | - Audrey Borghi-Silva
- b Department of Physiotherapy , Federal University of São Carlos (UFSCAR) , São Carlos , Brazil
| | - Luiz A Medina
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Rita Santos
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Daniel M Hirai
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil.,c Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , Canada
| | - Frederico Mancuso
- d Cardiology Division, Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Dirceu Almeida
- d Cardiology Division, Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Denis E O'Donnell
- e Respiratory Investigation Unit (RIU), Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , Canada
| | - J Alberto Neder
- a Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil.,c Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen's University , Kingston , Canada
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Neder JA, Jones JH, Zelt JTJ, Ramos RP, Ota-Arakaki JS, Hirai DM, Sperandio PA, Alencar MCN, Arbex FF, O'Donnell DE. Pulmonary artery wedge pressure and exercise oscillatory ventilation in pre-capillary pulmonary hypertension. Int J Cardiol 2015; 206:164-6. [PMID: 26577023 DOI: 10.1016/j.ijcard.2015.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Affiliation(s)
- J Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada.
| | - Joshua H Jones
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Joel T J Zelt
- Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Roberta P Ramos
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Pulmonary Vascular Group, Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Jaquelina S Ota-Arakaki
- Pulmonary Vascular Group, Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel M Hirai
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
| | - Priscila A Sperandio
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria Clara N Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Flavio F Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Respiratory Division, Department of Medicine, School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Denis E O'Donnell
- Respiratory Investigation Unit (RIU), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada
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Neder JA, Arbex FF, Alencar MCN, O’Donnell CD, Cory J, Webb KA, O’Donnell DE. Exercise ventilatory inefficiency in mild to end-stage COPD. Eur Respir J 2014; 45:377-87. [DOI: 10.1183/09031936.00135514] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Ventilatory inefficiency during exercise is a key pathophysiological feature of chronic obstructive pulmonary disease. Currently, it is unknown how this physiological marker relates to clinically relevant outcomes as resting ventilatory impairment progresses across disease stages.Slope and intercept of the linear region of the ventilation–carbon dioxide output relationship and the ratio between these variables, at the lowest point (nadir), were contrasted in 316 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1–4 (forced expiratory volume in 1 s, ranging from 148% pred to 12% pred) and 69 aged- and gender-matched controls,Compared to controls, slope and intercept were higher in GOLD stages 1 and 2, leading to higher nadirs (p<0.05). Despite even larger intercepts in GOLD stages 3 and 4, slopes diminished as disease evolved (from mean±sd35±6 in GOLD stage 1 to 24±5 in GOLD stage 3, p<0.05). As a result, there were no significant differences in nadirs among patient groups. Higher intercepts, across all stages (p<0.01), and to a lesser extent lower slopes in GOLD stages 2–4 (p<0.05), were related to greater mechanical constraints, worsening pulmonary gas exchange, higher dyspnoea scores, and poorer exercise capacity.Increases in the ventilation intercept best indicate the progression of exercise ventilatory inefficiency across the whole spectrum of chronic obstructive pulmonary disease severity.
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Arbex MA, de Souza Conceição GM, Cendon SP, Arbex FF, Lopes AC, Moysés EP, Santiago SL, Saldiva PHN, Pereira LAA, Braga ALF. Urban air pollution and chronic obstructive pulmonary disease-related emergency department visits. J Epidemiol Community Health 2009; 63:777-83. [PMID: 19468016 DOI: 10.1136/jech.2008.078360] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) can have recurrent disease exacerbations triggered by several factors, including air pollution. Visits to the emergency respiratory department can be a direct result of short-term exposure to air pollution. The aim of this study was to investigate the relationship between the daily number of COPD emergency department visits and the daily environmental air concentrations of PM(10), SO(2), NO(2), CO and O(3) in the City of São Paulo, Brazil. METHODS The sample data were collected between 2001 and 2003 and are categorised by gender and age. Generalised linear Poisson regression models were adopted to control for both short- and long-term seasonal changes as well as for temperature and relative humidity. The non-linear dependencies were controlled using a natural cubic spline function. Third-degree polynomial distributed lag models were adopted to estimate both lag structures and the cumulative effects of air pollutants. RESULTS PM(10) and SO(2) readings showed both acute and lagged effects on COPD emergency department visits. Interquartile range increases in their concentration (28.3 microg/m(3) and 7.8 microg/m(3), respectively) were associated with a cumulative 6-day increase of 19% and 16% in COPD admissions, respectively. An effect on women was observed at lag 0, and among the elderly the lag period was noted to be longer. Increases in CO concentration showed impacts in the female and elderly groups. NO(2) and O(3) presented mild effects on the elderly and in women, respectively. CONCLUSION These results indicate that air pollution affects health in a gender- and age-specific manner and should be considered a relevant risk factor that exacerbates COPD in urban environments.
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Affiliation(s)
- M A Arbex
- Internal Medicine Post- Graduate Programme, São Paulo Federal University, Medical School, São Paulo, Brazil.
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Pereira Filho MA, Pereira LAA, Arbex FF, Arbex M, Conceição GM, Santos UP, Lopes AC, Saldiva PHN, Braga ALF, Cendon S. Effect of air pollution on diabetes and cardiovascular diseases in São Paulo, Brazil. ACTA ACUST UNITED AC 2008; 41:526-32. [PMID: 18560673 DOI: 10.1590/s0100-879x2008005000020] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 04/17/2008] [Indexed: 04/08/2023]
Abstract
Type 2 diabetes increases the risk of cardiovascular mortality and these patients, even without previous myocardial infarction, run the risk of fatal coronary heart disease similar to non-diabetic patients surviving myocardial infarction. There is evidence showing that particulate matter air pollution is associated with increases in cardiopulmonary morbidity and mortality. The present study was carried out to evaluate the effect of diabetes mellitus on the association of air pollution with cardiovascular emergency room visits in a tertiary referral hospital in the city of São Paulo. Using a time-series approach, and adopting generalized linear Poisson regression models, we assessed the effect of daily variations in PM10, CO, NO2, SO2, and O3 on the daily number of emergency room visits for cardiovascular diseases in diabetic and non-diabetic patients from 2001 to 2003. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear term seasonal usage and weather variables. In this period, 45,000 cardiovascular emergency room visits were registered. The observed increase in interquartile range within the 2-day moving average of 8.0 microg/m(3) SO2 was associated with 7.0% (95%CI: 4.0-11.0) and 20.0% (95%CI: 5.0-44.0) increases in cardiovascular disease emergency room visits by non-diabetic and diabetic groups, respectively. These data indicate that air pollution causes an increase of cardiovascular emergency room visits, and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.
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Affiliation(s)
- M A Pereira Filho
- Programa de Pós-graduação em Clínica Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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