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Lung deflation and oxygen pulse in COPD: results from the NETT randomized trial.

Abstract：

BACKGROUND:In COPD patients, hyperinflation impairs cardiac function. We examined whether lung deflation improves oxygen pulse, a surrogate marker of stroke volume. METHODS:In 129 NETT patients with cardiopulmonary exercise testing (CPET) and arterial blood gases (ABG substudy), hyperinflation was assessed with residual volume to total lung capacity ratio (RV/TLC), and cardiac function with oxygen pulse (O(2) pulse=VO(2)/HR) at baseline and 6 months. Medical and surgical patients were divided into "deflators" and "non-deflators" based on change in RV/TLC from baseline (∆RV/TLC). We defined deflation as the ∆RV/TLC experienced by 75% of surgical patients. We examined changes in O(2) pulse at peak and similar (iso-work) exercise. Findings were validated in 718 patients who underwent CPET without ABGs. RESULTS:In the ABG substudy, surgical and medical deflators improved their RV/TLC and peak O(2) pulse (median ∆RV/TLC -18.0% vs. -9.3%, p=0.0003; median ∆O(2) pulse 13.6% vs. 1.8%, p=0.12). Surgical deflators also improved iso-work O(2) pulse (0.53 mL/beat, p=0.04 at 20 W). In the validation cohort, surgical deflators experienced a greater improvement in peak O(2) pulse than medical deflators (mean 18.9% vs. 1.1%). In surgical deflators improvements in O(2) pulse at rest and during unloaded pedaling (0.32 mL/beat, p<0.0001 and 0.47 mL/beat, p<0.0001, respectively) corresponded with significant reductions in HR and improvements in VO(2). On multivariate analysis, deflators were 88% more likely than non-deflators to have an improvement in O(2) pulse (OR 1.88, 95% CI 1.30-2.72, p=0.0008). CONCLUSION:In COPD, decreased hyperinflation through lung volume reduction is associated with improved O(2) pulse.

journal_name

Respir Med

journal_title

Respiratory medicine

authors

Come CE,Divo MJ,San José Estépar R,Sciurba FC,Criner GJ,Marchetti N,Scharf SM,Mosenifar Z,Make BJ,Keller CA,Minai OA,Martinez FJ,Han MK,Reilly JJ,Celli BR,Washko GR,NETT Research Group.

doi

10.1016/j.rmed.2011.07.012

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

109-19

issue

eissn

0954-6111

issn

1532-3064

pii

S0954-6111(11)00247-2

journal_volume

106

pub_type

杂志文章,随机对照试验

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Lung deflation and oxygen pulse in COPD: results from the NETT randomized trial.