Abstract
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 (’VO2), ’VO2 at anaerobic threshold, oxygen (O2) pulse and ’VE/’VCO2 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.
Acknowledgments
We give our acknowledgements to professor Vukov, who performed the statistical analysis.
Research funding: None declared.
Author contributions: The investigation was performed in Medical University, Sofia; University Hospital “Saint Sophia”, First Therapeutic Clinic. The design of the study was proposed by all authors. All authors have equally contributed to the recruitment and selection of patients. R. Cherneva performed the spirometry and the cardio-pulmonary exercise testing and Zh. Cherneva – echocardiography at rest and at peak stress. All authors have equally contributed to analysis of the data and writing of the manuscript. There was no funding.
Competing interests: All the authors state no conflict of interests.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: Ethics approval for the study protocol was received from the Ethics Committee of the Medical University, Sofia protocol 5/12.03.2018.
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