Crisafulli Ernesto, Scelfo Chiara, Tzani Panagiota, Aiello Marina, Bertorelli Giuseppina, Chetta Alfredo
Department of Medicine and Surgery, University of Parma, Parma, Italy.
Eur J Prev Cardiol. 2017 Jun;24(9):990-999. doi: 10.1177/2047487317695629. Epub 2017 Jan 1.
Background Silent/asymptomatic peripheral artery disease may occur in patients with chronic obstructive pulmonary disease, but it is poorly investigated. The primary aim of this study was to evaluate in chronic obstructive pulmonary disease patients the impact of asymptomatic/silent peripheral artery disease on maximal exercise capacity; the secondary aim was to search for predictors of peripheral artery disease. Methods We prospectively enrolled chronic obstructive pulmonary disease outpatients. Data on anthropometric characteristics, lung function, cardiopulmonary exercise test and ankle-brachial index were recorded. The cut-off of ankle-brachial index used to define patients with peripheral artery disease was ≤0.90. Results We studied 47 patients and found 24 patients (51%) who showed peripheral artery disease. As compared to patients without peripheral artery disease, patients with peripheral artery disease had lower values of peak oxygen uptake, peak workload, energy expenditure (metabolic equivalents) and heart rate recovery, but showed the same degree of airflow obstruction and static and dynamic hyperinflation. In a multivariate linear regression model performed to identify variables predicting metabolic equivalents, ankle-brachial index (β 2.59; 95% confidence interval 0.51-4.67; p = 0.016) was an independent variable. In the search for predictors of peripheral artery disease, heart rate recovery (odds ratio 8.80; 95% confidence interval 1.30-59.35; p = 0.026) increased the risk of peripheral artery disease, whereas metabolic equivalents (odds ratio 0.50; 95% confidence interval 0.26-0.94, p = 0.033) and inhaled corticosteroids+long-acting β agonists (odds ratio 0.13; 95% confidence interval 0.02-0.83; p = 0.030) reduced this risk. Conclusions In chronic obstructive pulmonary disease outpatients, asymptomatic/silent peripheral artery disease affects the maximal exercise capacity regardless of airflow obstruction and lung hyperinflation. A delay of heart rate recovery increase the risk of peripheral artery disease, whereas high values of metabolic equivalents and the use of inhaled corticosteroids+long-acting β agonists reduces this risk.
背景 慢性阻塞性肺疾病患者可能会发生无症状性外周动脉疾病，但对此研究较少。本研究的主要目的是评估慢性阻塞性肺疾病患者中无症状/静息性外周动脉疾病对最大运动能力的影响；次要目的是寻找外周动脉疾病的预测因素。方法 我们前瞻性纳入了慢性阻塞性肺疾病门诊患者。记录了人体测量学特征、肺功能、心肺运动试验和踝臂指数的数据。用于定义外周动脉疾病患者的踝臂指数临界值为≤0.90。结果 我们研究了47例患者，发现24例（51%）存在外周动脉疾病。与无外周动脉疾病的患者相比，外周动脉疾病患者的峰值摄氧量、峰值工作量、能量消耗（代谢当量）和心率恢复值较低，但气流阻塞程度以及静态和动态肺过度充气程度相同。在用于识别预测代谢当量变量的多变量线性回归模型中，踝臂指数（β 2.59；95%置信区间0.51 - 4.67；p = 0.016）是一个独立变量。在寻找外周动脉疾病的预测因素时，心率恢复（比值比8.80；95%置信区间1.30 - 59.35；p = 0.026）增加了外周动脉疾病的风险，而代谢当量（比值比0.50；95%置信区间0.26 - 0.94，p = 0.033）和吸入性糖皮质激素+长效β受体激动剂（比值比0.13；95%置信区间0.02 - 0.83；p = 0.030）降低了这种风险。结论 在慢性阻塞性肺疾病门诊患者中，无症状/静息性外周动脉疾病无论气流阻塞和肺过度充气情况如何都会影响最大运动能力。心率恢复延迟会增加外周动脉疾病的风险，而高代谢当量值以及使用吸入性糖皮质激素+长效β受体激动剂会降低这种风险。
