Left ventricular concentric remodeling in COPD patients: A cross-sectional observational study.

OBJECTIVE: To investigate the association between left ventricular structure and disease severity in COPD patients. METHODS: Twenty-eight COPD patients were stratified according to the disease severity, using the BODE index, into Lower (n=17) and Higher (n=11) groups, composed of patients with lower severity (BODE <5) and higher severity (BODE ≥5), respectively. Left ventricle (LV) was assessed by 2D-echocardiography. BODE index was calculated using body mass index (BMI); forced expiratory volume in the first second (FEV1, %); modified Medical Research Council (mMRC) and distance walked during 6-minute walk test (6MWD). RESULTS: Patients in the Higher group showed lower oxygen arterial saturation (p=0.02), FEV1 (p<0.01) and 6MWD (p=0.02) and higher value of relative posterior wall thickness (RWT) compared to Lower group (p=0.02). There were significant associations between LV end-systolic diameter (LVESD) and BODE index (r=-0.38, p=0.04), LV end-diastolic diameter (LVEDD) and FEV1 (r=0.44, p=0.02), LVEDD and BMI (r=0.45, p=0.02), LVESD and BMI (r=0.54, p=0.003) and interventricular septal thickness and 6MWD (r=-0.39, p=0.04). CONCLUSIONS: More severe COPD patients, BODE score ≥5, may have higher RWT, featuring a possible higher concentric remodeling of LV in this group. Besides that, a greater disease severity may be related to LV chamber size reduction.

The Effect of Adding Noninvasive Ventilation to High-Intensity Exercise on Peripheral and Respiratory Muscle Oxygenation.

BACKGROUND: We sought to assess whether noninvasive ventilation (NIV) as an adjunct with high-intensity exercise (HIEx) is more effective than exercise alone or exercise + sham on respiratory and peripheral oxygenation and vascular function in subjects with coexisting COPD and heart failure (HF). METHODS: On separate days, subjects performed incremental cardiopulmonary exercise testing and 3 constant load tests: HIEx, HIEx+NIV, and HIEx+sham (bi-level mode, Astral 150). Subjects were randomized with a 1:1 block allocation for the HIEx+NIV group and HIEx+sham group until the limit of tolerance (Tlim). Peripheral and respiratory oxygenation were assessed by oxyhemoglobin (O2Hb) and deoxyhemoglobin (Hb) using near-infrared spectroscopy in the respiratory and peripheral musculature. Vascular function was assessed by endothelial function using the flow-mediated vasodilation (FMD) method. RESULTS: There was a significant increase in FMD (mm), FMD (%), and shear stress in the HIEx+NIV group when compared to HIEx or HIEx+sham (P < .05). Less extraction of O2 (Hb) in the peripheral and respiratory muscles was observed in the HIEx+NIV group (P < .05). We also found correlations between peripheral muscle oxygenation (O2Hb) at the moment 80% of Tlim (r = 0.71, P = .009) and peak of Tlim (100%) (r = 0.76, P = .004) with absolute FMD (mm) immediately after HIEx+NIV. CONCLUSIONS: NIV as an adjunct to HIEx can acutely unload the respiratory musculature with better redistribution of available blood flow and beneficially modulate endothelial function. These results may influence the approach to cardiopulmonary rehabilitation in patients with coexisting COPD-HF.

Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson's disease: Randomized controlled clinical trial protocol.

BACKGROUND: Individuals with Parkinson's disease (PD), in addition to motor impairment, may evolve with respiratory and autonomic nervous system disorders. Currently, there are few studies with emphasis on muscle and pulmonary dysfunction and that verify the benefits of inspiratory muscle training (IMT) in this population. AIM: The aim of this study was to evaluate whether IMT is effective for the improvement of respiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in PD. METHODS: A randomized and controlled trial will be conducted with 26 participants with idiopathic PD, with aged between 50 and 65 years, in the Stages I to III by the Modified Hoehn and Yahr Scale. Respiratory muscle strength will be performed by manovacuometry and lung function by spirometry. Functional capacity will be evaluated by the 6-min walk test and autonomic cardiac function by heart rate variability. In addition, thoracic mobility measurement will also be performed. After the evaluations, these participants will be randomly assigned to two groups: the IMT group with Powerbreathe® , which will perform the eight series of 2 min each, with 1 min of rest between them, totaling 30 min, at 60% of the maximum inspiratory pressure and the control group, who will perform the same training protocol but with the load maintained at 9 cmH2 O. All participants will be submitted to the same motor training protocol. CONCLUSION: It is expected that IMT increases the inspiratory muscle strength, contributing to the improved expiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in individuals with mild to moderate PD.