Why the study?
Autonomic dysfunction and dynamic hyperinflation are implicated in HFpEF in COPD patients, but their association remains elusive.
What is the prevalence of autonomic dysfunction and dynamic hyperinflation, and their association with masked HFpEF in non-severe COPD patients with exertional dyspnea?
What is the prevalence of autonomic dysfunction and dynamic hyperinflation, and their association with masked HFpEF in non-severe COPD patients with exertional dyspnea?
Dynamic hyperinflation and autonomic dysfunction are highly prevalent in non-severe COPD patients with masked HFpEF, and DH is independently associated with AD, though neither independently predicts masked HFpEF.
Answers are grounded in this paper and cite their sources.
AD and DH prevalent in symptomatic non-severe COPD without overt CV disease; leaves open links to masked HFpEF.
Objectives Autonomic dysfunction (AD) and dynamic hyperinflation (DH) have been implicated as pathophysiological mechanisms of heart failure with preserved ejection fraction (HFpEF) in chronic obstructive pulmonary disease ( COPD) patients. Their association, however, remains elusive: The aims of the study were: (1) to determine the prevalence of AD and DH in non-severe COPD patients, with exertional dyspnea, without clinically overt cardio-vascular (CV) comorbidities; (2) to analyze the correlation and clinical significance between DH, AD, and maksed HFpEF. Methods We applied CPET in 68 subjects. Echocardiography was performed before CPET and 1–2 min after peak exercise. IC manoeuvres were applied. Patients were divided into two groups: patients with and without masked HFpEF. Wilkoff method calculated the meatabolic – chronotropic relationship (MCR). Chronotropic incompetence (CI) and abnormal HR recovery (HRR) were determined. Results The prevalence of CI was 77 vs. 52% in patients with/without masked HFpEF; of abnormal HRR – 98 vs. 62% respectively; of DH – 53 vs. 29%. ICdyn was associated with AD. Univariate regression showed association between masked HFpEF, ICdyn, HRR, oxygenuptake (’VO 2 ), ’VO 2 at anaerobic threshold, oxygen (O 2 ) pulse and ’VE/’VCO 2 slope. None of these parameters is an independent predictor for masked HFpEF. Conclusions DH, AD, and masked HFpEF are prevalent in non-severe COPD patients, who complain of exertional dyspnea and are free of clinically overt CV comorbidities. DH is independently associated with AD. Neither AD, nor DH and CPET are independent predictors for masked HFpEF.
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Cherneva et al. (2020) studied this question.
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