Non-invasive ventilation improves exercise tolerance and peripheral vascular function after high-intensity exercise in COPD-HF patients

• Autor(a) principal: Goulart, Cássia da Luz
• Data de Publicação: 2020
• Outros Autores: Caruso, Flávia Rossi, Araújo, Adriana Sanches Garcia de, Arêas, Guilherme Peixoto Tinoco, Moura, Silvia Cristina Garcia de, Catai, Aparecida Maria, Mendes, Renata Gonçalves, Phillips, Shane A., Arena, Ross, Silva, Andréa Lúcia Gonçalves da, Silva, Audrey Borghi
• Tipo de documento: Conjunto de dados
• Idioma: eng
• Título da fonte: Repositório Institucional da UFSCAR
• Texto Completo: https://doi.org/10.1016/j.rmed.2020.106173; https://repositorio.ufscar.br/handle/ufscar/15580
• topic: COPD; Endothelial function; Exercise test; Heart failure; Ventilation; CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL

Aim: 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). Methods: 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. Results: Our patients had a mean age of 70 ± 7 years, FEV1 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 SpO2 (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. Conclusion: 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.