Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil; Human Physiology Laboratory, Physiology Department, Federal University of Amazonas, UFAM, v. General Rodrigo Octávio, 6200, Coroado I, CEP: 69080-900, Manaus, AM, Brazil.
Heart Lung. 2021 Jan-Feb;50(1):113-120. doi: 10.1016/j.hrtlng.2020.06.013. Epub 2020 Jul 21.
To investigate cerebral oxygenation (Cox) responses as well as respiratory (Res) and active peripheral muscle (Pm) O delivery during high-intensity cycling exercise and contrast responses between patients with coexistent chronic obstructive pulmonary disease (COPD)-heart failure (HF) and HF alone.
Cross-sectional study involving 11 COPD-HF and 11 HF patients. On two different days, patients performed maximal incremental cardiopulmonary exercise testing (CPET) and constant load exercise on a cycle ergometer until the limit of tolerance (Tlim). The high-intensity exercise session was 80% of the peak CPET work rate. Relative blood concentrations of oxyhemoglobin ([OHb]), deoxyhemoglobin ([HHb]) of Res, Pm (right vastus lateralis) and Cox (pre-frontal) were measured using near infrared spectroscopy.
We observed a greater decrease in [OHb] at a lower Tlim in COPD-HF when compared to HF (P < 0.05). [HHb] of Res was higher (P < 0.05) and Tlim was lower in COPD-HF vs. HF. Pm and Cox were lower and Tlim was higher in (P < 0.05) HF vs. COPD-HF. In HF, there was a lower ∆[OHb] and higher ∆ [HHb] of Pm when contrasted to Cox observed during exercise, as well as a lower ∆ [OHb] and higher ∆ [HHb] of Res when contrasted with Cox (P < 0.05). However, COPD-HF patients presented with a higher ∆ [HHb] of Res and Pm when contrasted with Cox (P < 0.05).
The coexistence of COPD in patients with HF produces negative effects on Cox, greater deoxygenation of the respiratory and peripheral muscles and higher exertional dyspnea, which may help to explain an even lower exercise tolerance in this multimorbidity phenotype.
研究高强度骑行运动时脑氧合（Cox）反应以及呼吸（Res）和主动外周肌肉（Pm）的 O 输送，并对比同时患有慢性阻塞性肺疾病（COPD）-心力衰竭（HF）和单纯 HF 患者的反应。
这是一项涉及 11 名 COPD-HF 患者和 11 名 HF 患者的横断面研究。在两天的不同时间，患者进行了最大递增心肺运动测试（CPET）和在固定功率自行车上进行直至耐受极限（Tlim）的恒定负荷运动。高强度运动部分为峰值 CPET 工作率的 80%。使用近红外光谱法测量了 Res、Pm（右股外侧肌）和 Cox（额前叶）的相对血氧血红蛋白（[OHb]）、脱氧血红蛋白（[HHb]）浓度。
与 HF 患者相比，COPD-HF 患者在较低的 Tlim 时 [OHb]下降幅度更大（P<0.05）。Res 的 [HHb]更高（P<0.05），且 Tlim 更低（P<0.05）。与 COPD-HF 患者相比，HF 患者的 Pm 和 Cox 更低，Tlim 更高（P<0.05）。在 HF 患者中，与 Cox 相比，运动时 Pm 的 ∆[OHb]较低，∆[HHb]较高（P<0.05），Res 的 ∆[OHb]和 ∆[HHb]也较低（P<0.05）。然而，与 Cox 相比，COPD-HF 患者的 Res 和 Pm 的 ∆[HHb]更高（P<0.05）。
HF 患者中 COPD 的共存对 Cox 产生负面影响，导致呼吸和外周肌肉的脱氧程度更大，运动时呼吸困难程度更高，这可能有助于解释这种合并症表型的运动耐量更低。
