Patterns of Oxygen Pulse Curve in Response to Incremental Exercise in Patients with Chronic Obstructive Pulmonary Disease - An Observational Study.

In COPD, pulmonary hyperinflation causes decreased stroke volume thereby decreased oxygen pulse (OP). While OP flattening is related to myocardial ischemia in cardiac patients, OP patterns have seldom been explored in COPD. The aims of the study were to investigate OP-curve patterns and associated factors in COPD. Seventy-five patients with stable COPD were enrolled. The demographics, cardiac size, physiological measurements and stress EKG were compared among OP-curve pattern groups. An algorithm to identify OP-curve patterns was developed in 28 patients. In the remaining 45 patients after excluding two with poor effort, this algorithm revealed 20 (44%) flattening, 16 (36%) increasing, and nine (20%) decreasing patterns. The flattening-type group had lower body mass, cardiac size, and diffusing capacity, and larger lung volumes (p = 0.05-<0.0001) compared to the increasing-type group. During exercise, the flattening-type group had a lower operable OP and more hyperventilation and dyspnea (p = 0.02-<0.01). None had ST-T changes. Most differences were related to body mass and mildly to inspiratory fraction. The decreasing-type group performed higher effort than the increasing-type group (p < 0.05). In conclusion, OP flattening was common and was associated with reduced body mass and pulmonary hyperinflation rather than with myocardial ischemia. The decreasing-type may be caused by motivation to exercise.