Mechanisms of exercise limitation in patients with combined fibrosis and pulmonary emphysema
| Autor: | Camila M. Costa, Marcelle Paula Ribeiro, Roberta Pulcheri Ramos, Carolina S.M. Messina, Jaquelina Sonoe Ota Arakaki, Carlos Alberto de Castro Pereira, Eloara Vm Ferreira, Angelo X.C. Fonseca |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
education.field_of_study business.industry Population respiratory system medicine.disease Pulmonary hypertension Combined pulmonary fibrosis and emphysema Pulmonary function testing FEV1/FVC ratio DLCO Internal medicine Cardiology Medicine Transthoracic echocardiogram business Dynamic hyperinflation education |
| Zdroj: | Clinical Respiratory Physiology, Exercise and Functional Imaging. |
| DOI: | 10.1183/1393003.congress-2017.pa4539 |
| Popis: | Introduction: Exercise impairment (EI) is a common feature in patients with combined pulmonary fibrosis and emphysema (CPFE). As the prevalence of pulmonary hypertension (PH) in this population is high, our hypothesis is that the main mechanism of EI is cardiocirculatory. OBJECTIVES: To evaluate the mechanisms of EI by incremental cardiopulmonary exercise test (CPET) and the bronchodilator (BD) response. Methods: 24 CPFE patients (79% males, 68 ± 6yrs, FEV1/FVC 0.78±0.09, FVC 86 ± 15% pred, FEV1 88±15%pred, TLC 83±13%pred, DLCO: 38±12.7%pred) were included in a prospective, double-blind, crossover study. Patients performed transthoracic echocardiogram (ECHO), lung function tests, incremental and constant-load CPET with placebo and BD. Results: At incremental CPET, 62% presented cardiocirculatory limitation, 4% ventilatory limitation and 100% desaturation. Functional variables that were most associated with the cardiocirculatory limitation were the DLCO with a cutoff point of 42% (sensitivity: 66.7%, specificity: 92.3%) and FVC / DLCO ratio ≥ 2.2 (sensitivity: 69%, specificity: 88.9%), whilst the ECHO variable was the RV size of 20 mm (sensitivity: 75%, specificity: 77.8%). Multivariate logistic regression analysis revealed that the FVC/DLCO ratio was associated with cardiocirculatory limitation independently of RV size. Of the 17 patients who completed the protocol with placebo and BD, 9 (52%) presented dynamic hyperinflation, of which only 3 responded to the BD. Those who did not respond also had cardiocirculatory limitation. Conclusions: The main mechanism of EI in CPFE patients is cardiocirculatory limitation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|