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, Manaus, AM, Brazil.
Respir Med. 2020 Nov;173:106173. doi: 10.1016/j.rmed.2020.106173. Epub 2020 Sep 25.
Evaluate the acute effects of non-invasive positive pressure ventilation (NiPPV) during high-intensity exercise on endothelial function in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF).
This is a randomized, double blinded, sham-controlled study involving 14 COPD-HF patients, who underwent a lung function test and Doppler echocardiography. On two different days, patients performed incremental cardiopulmonary exercise testing (CPET) and two constant-work rate tests (80% of CPET peak) receiving Sham or NiPPV (bilevel mode - Astral 150) in a random order until the limit of tolerance (Tlim). Endothelial function was evaluated by flow mediated vasodilation (FMD) at three time points: 1) Baseline; 2) immediately post-exercise with NiPPV; and 3) immediately post-exercise with Sham.
Our patients had a mean age of 70 ± 7 years, FEV 1.9 ± 0.7 L and LVEF 41 ± 9%. NIPPV resulted in an increased Tlim (NiPPV: 130 ± 29s vs Sham: 98 ± 29s p = 0.015) and SpO (NiPPV: 94.7 ± 3.5% vs Sham: 92.7 ± 5.2% p = 0.03). Also, NiPPV was able to produce a significant increase in FMD (%) (NiPPV: 9.2 ± 3.1 vs Sham: 3.6 ± 0.7, p < 0.05), FMD (mm) (NiPPV: 0.41 ± 0.18 vs Sham: 0.20 ± 0.11, p < 0.05), Blood flow velocity (NiPPV: 33 ± 18 vs Baseline: 20 ± 14, p < 0.05) and Shear Stress (SS) (NiPPV: 72 ± 38 vs Baseline: 43 ± 25, p < 0.05). We found correlation between Tlim vs. ΔSS (p = 0.03; r = 0.57). Univariate-regression analysis revealed that increased SS influenced 32% of Tlim during exercise with NiPPV.
NiPPV applied during high-intensity exercise can acutely modulate endothelial function and improve exercise tolerance in COPD-HF patients. In addition, the increase of SS positively influences exercise tolerance.
评估在合并慢性阻塞性肺疾病（COPD）和心力衰竭（HF）的患者中，高强度运动期间无创正压通气（NiPPV）对内皮功能的急性影响。
这是一项随机、双盲、假对照研究，共纳入 14 名 COPD-HF 患者，他们接受了肺功能测试和多普勒超声心动图检查。在两天的不同时间，患者进行了递增心肺运动测试（CPET）和两个恒定工作率测试（CPET 峰值的 80%），在耐受性极限（Tlim）之前，以随机顺序分别接受假对照或 NiPPV（双水平模式-Astral 150）。内皮功能通过血流介导的血管扩张（FMD）在三个时间点进行评估：1）基础状态；2）运动后即刻给予 NiPPV；3）运动后即刻给予假对照。
我们的患者平均年龄为 70±7 岁，FEV 1.9±0.7 L，LVEF 41±9%。NiPPV 导致 Tlim 增加（NiPPV：130±29s 与 Sham：98±29s，p=0.015）和 SpO 增加（NiPPV：94.7±3.5% 与 Sham：92.7±5.2%，p=0.03）。此外，NiPPV 能够显著增加 FMD（%）（NiPPV：9.2±3.1 与 Sham：3.6±0.7，p<0.05）、FMD（mm）（NiPPV：0.41±0.18 与 Sham：0.20±0.11，p<0.05）、血流速度（NiPPV：33±18 与基础状态：20±14，p<0.05）和切应力（SS）（NiPPV：72±38 与基础状态：43±25，p<0.05）。我们发现 Tlim 与 ΔSS 之间存在相关性（p=0.03；r=0.57）。单变量回归分析显示，在 NiPPV 应用于高强度运动期间，增加的 SS 影响了运动时 32%的 Tlim。
在高强度运动期间应用 NiPPV 可以急性调节 COPD-HF 患者的内皮功能并提高运动耐量。此外，SS 的增加对运动耐量有积极影响。
