Article Dans Une Revue BMJ open respiratory research Année : 2024

Haemodynamic compensations for exercise tissue oxygenation in early stages of COPD: an integrated cardiorespiratory assessment study

Ruddy Richard
Dennis Jensen
  • Fonction : Auteur
Julianne Touron
  • Fonction : Auteur
Costes Frederic
  • Fonction : Auteur
Aurélien Mulliez
  • Fonction : Auteur
Laura Filaire
Darcy Marciniuk
  • Fonction : Auteur
François Maltais
  • Fonction : Auteur
Wan Tan
  • Fonction : Auteur
Jean Bourbeau
Hélène Perrault
  • Fonction : Auteur

Résumé

Background Cardiovascular comorbidities are increasingly being recognised in early stages of chronic obstructive pulmonary disease (COPD) yet complete cardiorespiratory functional assessments of individuals with mild COPD or presenting with COPD risk factors are lacking. This paper reports on the effectiveness of the cardiocirculatory-limb muscles oxygen delivery and utilisation axis in smokers exhibiting no, or mild to moderate degrees of airflow obstruction using standardised cardiopulmonary exercise testing (CPET). Methods Post-bronchodilator spirometry was used to classify participants as ‘ever smokers without’ (n=88), with ‘mild’ (n=63) or ‘mild-moderate’ COPD (n=56). All underwent CPET with continuous concurrent monitoring of oxygen uptake (V’O 2 ) and of bioimpedance cardiac output (Qc) enabling computation of arteriovenous differences (a-vO 2 ). Mean values of Qc and a-vO 2 were mapped across set ranges of V’O 2 and Qc isolines to allow for meaningful group comparisons, at same metabolic and circulatory requirements. Results Peak exercise capacity was significantly reduced in the ‘mild-moderate COPD’ as compared with the two other groups who showed similar pulmonary function and exercise capacity. Self-reported cardiovascular and skeletal muscle comorbidities were not different between groups, yet disease impact and exercise intolerance scores were three times higher in the ‘mild-moderate COPD’ compared with the other groups. Mapping of exercise Qc and a-vO 2 also showed a leftward shift of values in this group, indicative of a deficit in peripheral O 2 extraction even for submaximal exercise demands. Concurrent with lung hyperinflation, a distinctive blunting of exercise stroke volume expansion was also observed in this group. Conclusion Contrary to the traditional view that cardiovascular complications were the hallmark of advanced disease, this study of early COPD spectrum showed a reduced exercise O 2 delivery and utilisation in individuals meeting spirometry criteria for stage II COPD. These findings reinforce the preventive clinical management approach to preserve peripheral muscle circulatory and oxidative capacities.

Dates et versions

hal-04861638 , version 1 (02-01-2025)

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Citer

Ruddy Richard, Dennis Jensen, Julianne Touron, Costes Frederic, Aurélien Mulliez, et al.. Haemodynamic compensations for exercise tissue oxygenation in early stages of COPD: an integrated cardiorespiratory assessment study. BMJ open respiratory research, 2024, 11 (1), pp.e002241. ⟨10.1136/bmjresp-2023-002241⟩. ⟨hal-04861638⟩
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