| Lung deflation and oxygen pulse in COPD: Results from the NETT randomized trial. | |
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MedLine Citation:
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PMID: 21843930 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: In COPD patients, hyperinflation impairs cardiac function. We examined whether lung deflation improves oxygen pulse, a surrogate marker of stroke volume. METHODS: In 129 NETT patients with cardiopulmonary exercise testing (CPET) and arterial blood gases (ABG substudy), hyperinflation was assessed with residual volume to total lung capacity ratio (RV/TLC), and cardiac function with oxygen pulse (O(2) pulse=VO(2)/HR) at baseline and 6 months. Medical and surgical patients were divided into "deflators" and "non-deflators" based on change in RV/TLC from baseline (∆RV/TLC). We defined deflation as the ∆RV/TLC experienced by 75% of surgical patients. We examined changes in O(2) pulse at peak and similar (iso-work) exercise. Findings were validated in 718 patients who underwent CPET without ABGs. RESULTS: In the ABG substudy, surgical and medical deflators improved their RV/TLC and peak O(2) pulse (median ∆RV/TLC -18.0% vs. -9.3%, p=0.0003; median ∆O(2) pulse 13.6% vs. 1.8%, p=0.12). Surgical deflators also improved iso-work O(2) pulse (0.53mL/beat, p=0.04 at 20W). In the validation cohort, surgical deflators experienced a greater improvement in peak O(2) pulse than medical deflators (mean 18.9% vs. 1.1%). In surgical deflators improvements in O(2) pulse at rest and during unloaded pedaling (0.32mL/beat, p<0.0001 and 0.47mL/beat, p<0.0001, respectively) corresponded with significant reductions in HR and improvements in VO(2). On multivariate analysis, deflators were 88% more likely than non-deflators to have an improvement in O(2) pulse (OR 1.88, 95% CI 1.30-2.72, p=0.0008). CONCLUSION: In COPD, decreased hyperinflation through lung volume reduction is associated with improved O(2) pulse. |
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Authors:
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Carolyn E Come; Miguel J Divo; Raúl San José Estépar; Frank C Sciurba; Gerard J Criner; Nathaniel Marchetti; Steven M Scharf; Zab Mosenifar; Barry J Make; Cesar A Keller; Omar A Minai; Fernando J Martinez; Meilan K Han; John J Reilly; Bartolome R Celli; George R Washko; |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-8-13 |
Journal Detail:
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Title: Respiratory medicine Volume: - ISSN: 1532-3064 ISO Abbreviation: - Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-8-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8908438 Medline TA: Respir Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Elsevier Ltd. All rights reserved. |
Affiliation:
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Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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