Department of Pathophysiology, Erasme University Hospital, Brussels, Belgium.
Respir Med. 2010 Jan;104(1):121-6. doi: 10.1016/j.rmed.2009.06.006. Epub 2009 Jul 3.
Pulmonary hypertension is a common occurrence in advanced COPD, but its effects on exercise capacity remain undetermined. Exercise testing and an echocardiographic examination were performed in 29 patients with advanced stable COPD. Mean pulmonary artery pressure (mPAP) was calculated from the acceleration time of pulmonary flow. Exercise capacity was evaluated by the distance walked in 6 min (6MWD) and by an incremental cardiopulmonary exercise test (CPET). The patients had a forced expiratory volume in 1s of 1.13+/-0.49 L, and a 6MWD of 305+/-66 m (mean+/-SD). The CPET (n=24) showed a: maximum workload of 52+/-25 W, a peak O(2) uptake of 13.8+/-4.4 mL/kg/min, a peak heart rate of 127+/-22 bpm, a peak respiratory exchange ratio 1.06+/-0.11, a ventilation (V(E))/CO(2) production slope of 37+/-11, and a peak O(2) pulse 7.5+/-2.3 mL. The peak V(E) was 41+/-15 L/min, and the calculated maximum voluntary V(E) 45+/-20 L/min. There was no difference in any of the CPET variables and 6MWD between the patients with a mPAP<30 mm Hg (mPAP 22+/-6 mm Hg, n=15) and those with a mPAP>30 mm Hg (mPAP 38+/-6 mm Hg, n=14). There was no correlation between PAP and any of the exercise measurements. These results suggest that exercise capacity in unselected patients with advanced COPD and mild to moderate pulmonary hypertension is essentially limited by exhaustion of the ventilatory reserve.
肺动脉高压在晚期 COPD 中很常见，但它对运动能力的影响仍不确定。对 29 例晚期稳定 COPD 患者进行了运动试验和超声心动图检查。平均肺动脉压（mPAP）通过肺血流量加速时间计算。运动能力通过 6 分钟步行距离（6MWD）和递增心肺运动试验（CPET）评估。患者的 1 秒用力呼气量为 1.13+/-0.49 L，6MWD 为 305+/-66 m（平均值+/-标准差）。CPET（n=24）显示：最大工作量为 52+/-25 W，峰值 O(2)摄取量为 13.8+/-4.4 mL/kg/min，峰值心率为 127+/-22 bpm，峰值呼吸交换率为 1.06+/-0.11，通气（V(E))/CO(2)产量斜率为 37+/-11，峰值 O(2)脉冲为 7.5+/-2.3 mL。峰值 V(E)为 41+/-15 L/min，计算出的最大自主 V(E)为 45+/-20 L/min。在 mPAP<30 mmHg（mPAP 22+/-6 mmHg，n=15）和 mPAP>30 mmHg（mPAP 38+/-6 mmHg，n=14）的患者中，CPET 变量和 6MWD 没有差异。PAP 与任何运动测量值之间均无相关性。这些结果表明，在未经选择的晚期 COPD 合并轻度至中度肺动脉高压患者中，运动能力主要受通气储备衰竭的限制。
