Medina Luiz Antônio Rodrigues, Oliveira Mayron F, Santos Rita de Cassia Lima Dos, Souza Aline Soares de, Mazzuco Adriana, Sperandio Priscila Cristina de Abreu, Alencar Maria Clara Noman de, Arbex Flávio Ferlin, Neder J Alberto, Medeiros Wladimir Musetti
Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil.
VO2 Care Research Group, Physiotherapy Unit, Vila Nova Star Hospital, São Paulo, SP, Brazil.
Acta Cardiol. 2024 Jun;79(4):454-463. doi: 10.1080/00015385.2024.2319955. Epub 2024 Feb 29.
Exercise intolerance and dyspnoea are clinical symptoms in both heart failure (HF) reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD), which are suggested to be associated with musculoskeletal dysfunction. We tested the hypothesis that HFrEF + COPD patients would present lower muscle strength and greater fatigue compared to compared to the COPD group.
We included 25 patients with HFrEF + COPD (100% male, age 67.8 ± 6.9) and 25 patients with COPD alone (100% male, age 66.1 ± 9.1). In both groups, COPD severity was determined as moderate-to-severe according to the GOLD classification (FEV1/FVC < 0.7 and predicted post-bronchodilator FEV1 between 30%-80%). Knee flexor-extensor muscle performance (torque, work, power and fatigue) were measured by isokinetic dynamometry in age and sex-matched patients with HFrEF + COPD and COPD alone; Functional capacity was assessed by the cardiopulmonary exercise test, the 6-min walk test (6MWT) and the four-minute step test.
The COPD group exhibited reduced lung function compared to the HFrEF + COPD group, as evidenced by lower FEV/FVC (58.0 ± 4.0 vs. 65.5 ± 13.9; < 0.0001, respectively) and FEV (51.3 ± 17.0 vs. 62.5 ± 17.4; = 0.026, respectively) values. Regarding musculoskeletal function, the HFrEF + COPD group showed a knee flexor muscles impairment, however this fact was not observed in the knee extensors muscles. Power peak of the knee flexor corrected by muscle mass was significantly correlated with the 6MWT ( = 0.40; < 0.05), number of steps ( = 0.30; < 0.05) and work rate ( = 0.40; < 0.05) in the HFrEF + COPD and COPD groups.
The presence of HFrEF in patients with COPD worsens muscular weakness when compared to isolated COPD.
运动不耐受和呼吸困难是射血分数降低的心力衰竭（HFrEF）和慢性阻塞性肺疾病（COPD）的临床症状，提示与肌肉骨骼功能障碍有关。我们检验了以下假设：与COPD组相比，HFrEF合并COPD患者的肌肉力量更低，疲劳感更强。
我们纳入了25例HFrEF合并COPD患者（100%为男性，年龄67.8±6.9岁）和25例单纯COPD患者（100%为男性，年龄66.1±9.1岁）。两组中，根据GOLD分类法（FEV1/FVC<0.7且支气管扩张剂后预测FEV1在30%-80%之间），COPD严重程度被判定为中重度。通过等速测力法测量年龄和性别匹配的HFrEF合并COPD患者及单纯COPD患者的膝屈伸肌肌肉性能（扭矩、功、功率和疲劳）；通过心肺运动试验、6分钟步行试验（6MWT）和四分钟台阶试验评估功能能力。
与HFrEF合并COPD组相比，COPD组肺功能降低，FEV/FVC（分别为58.0±4.0 vs. 65.5±13.9；<0.0001）和FEV（分别为51.3±17.0 vs. 62.5±17.4；=0.026）值可证明。关于肌肉骨骼功能，HFrEF合并COPD组显示膝屈肌受损，然而在膝伸肌中未观察到这一情况。在HFrEF合并COPD组和COPD组中，经肌肉质量校正的膝屈肌功率峰值与6MWT（=0.40；<0.05）、步数（=0.30；<0.05）和工作率（=0.40；<0.05）显著相关。
与单纯COPD相比，COPD患者中存在HFrEF会使肌肉无力恶化。
