Non-invasive ventilation improves exercise tolerance and peripheral vascular function after high-intensity exercise in COPD-HF patients

Author(s):Show less -

Goulart, Cassia da Luz ^[1] ; Caruso, Flavia Rossi ^[1] ; de Araujo, Adriana S. Garcia ^[1] ; Tinoco Are, Guilherme Peixoto ^[2] ; Garcia de Moura, Silvia Cristina ^[3] ; Catai, Aparecida Maria ^[3] ; Mendes, Renata Goncalves ^[1] ; Phillips, Shane A. ^[4] ; Arena, Ross ^[4] ; Goncalves da Silva, Andrea Lucia ^[5] ; Borghi-Silva, Audrey ^[1]

Affiliation

^[1] Univ Fed Sao Carlos, Physiotherapy Dept, Cardiopulm Physiotherapy Lab, UFSCar, KM 235, BR-13565905 Sao Carlos, SP - Brazil

^[2] Univ Fed Amazonas, Physiol Dept, Human Physiol Lab, UFAM, Manaus, AM - Brazil

^[3] Univ Fed Sao Carlos, Physiotherapy Dept, Cardiovasc Phys Therapy Lab, Rod Washington Luis, KM 235, BR-13565905 Sao Carlos, SP - Brazil

^[4] Univ Illinois Chicago UIC, Coll Appl Hlth Sci, Integrat Physiol Lab, Dept Phys Therapy, Chicago, IL - USA

^[5] Univ Santa Cruz do Sul, Dept Phys Educ & Hlth, Santa Cruz Do Sul, RS - Brazil

• Document type: Journal article
• Source: RESPIRATORY MEDICINE; v. 173, NOV 2020.
• Web of Science Citations: 0

Abstract

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 SpO(2) (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. Delta SS (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. (AU)

• FAPESP's process: 18/03233-0 - Study of cardiorespiratory interaction and the supply of peripheral and cerebral oxygen as modulators of exercise capacity during bilevel application in the coexistence of COPD-CHF
• Grantee: Cássia da Luz Goulart
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)