Why the study?
The impact of coexistent heart failure and chronic obstructive pulmonary disease on exercise performance, contrasting exercise responses, and subsequent cardiopulmonary events needed evaluation.
Does the coexistence of HF and COPD reduce exercise capacity compared to HF or COPD alone?
Does the coexistence of HF and COPD reduce exercise capacity compared to HF or COPD alone?
The coexistence of heart failure and COPD significantly impairs exercise capacity and cardiopulmonary responses compared to either condition alone.
HF+COPD overlap was associated with reduced exercise capacity; leaves open whether this warrants integrated management or affects outcomes.
Our aim was to evaluate: (1) the prevalence of coexistence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the studied patients; (2) the impact of HF + COPD on exercise performance and contrasting exercise responses in patients with only a diagnosis of HF or COPD; and (3) the relationship between clinical characteristics and measures of cardiorespiratory fitness; (4) verify the occurrence of cardiopulmonary events in the follow-up period of up to 24 months years. The current study included 124 patients (HF: 46, COPD: 53 and HF + COPD: 25) that performed advanced pulmonary function tests, echocardiography, analysis of body composition by bioimpedance and symptom-limited incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Key CPET variables were calculated for all patients as previously described. The V̇ V ˙ E / V̇ V ˙ CO 2 slope was obtained through linear regression analysis. Additionally, the linear relationship between oxygen uptake and the log transformation of V̇ V ˙ E (OUES) was calculated using the following equation: V̇ V ˙ O 2 = a log V̇ V ˙ E + b, with the constant ‘a’ referring to the rate of increase of V̇ V ˙ O 2 . Circulatory power (CP) was obtained through the product of peak V̇ V ˙ O 2 and peak systolic blood pressure and Ventilatory Power (VP) was calculated by dividing peak systolic blood pressure by the V̇ V ˙ E / V̇ V ˙ CO 2 slope. After the CPET, all patients were contacted by telephone every 6 months (6, 12, 18, 24) and questioned about exacerbations, hospitalizations for cardiopulmonary causes and death. We found a 20% prevalence of HF + COPD overlap in the studied patients. The COPD and HF + COPD groups were older (HF: 60 ± 8, COPD: 65 ± 7, HF + COPD: 68 ± 7). In relation to cardiac function, as expected, patients with COPD presented preserved ejection fraction (HF: 40 ± 7, COPD: 70 ± 8, HF + COPD: 38 ± 8) while in the HF and HF + COPD demonstrated similar levels of systolic dysfunction. The COPD and HF + COPD patients showed evidence of an obstructive ventilatory disorder confirmed by the value of %FEV 1 (HF: 84 ± 20, COPD: 54 ± 21, HF + COPD: 65 ± 25). Patients with HF + COPD demonstrated a lower work rate (WR), peak oxygen uptake ( V̇ V ˙ O 2 ), rate pressure product (RPP), CP and VP compared to those only diagnosed with HF and COPD. In addition, significant correlations were observed between lean mass and peak V̇ V ˙ O 2 (r: 0.56 p < 0.001), OUES (r: 0.42 p < 0.001), and O 2 pulse (r: 0.58 p < 0.001), lung diffusing factor for carbon monoxide (D LCO ) and WR (r: 0.51 p < 0.001), D LCO and VP (r: 0.40 p: 0.002), forced expiratory volume in first second (FEV 1 ) and peak V̇ <mml:math xmlns:mml="http://www.w3.org/1
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Santos et al. (2022) studied this question.
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