Molecular Characteristics and Treatment of Endothelial Dysfunction in Patients with COPD: A Review Article.

Patients with chronic obstructive pulmonary disease (COPD) show systemic consequences, such as chronic systemic inflammation leading to changes in the airway, airway penetrability, and endothelial function. Endothelial dysfunction is characterized by a list of alterations of endothelium towards reduced vasodilation, proinflammatory state, detachment and apoptosis of endothelial cells, and development of atherosclerosis. COPD-induced endothelial dysfunction is associated with elevated cardiovascular risk. The increment of physical activities such as pulmonary rehabilitation (PR) training have a significant effect on COPD, thus, PR can be an integrative part of COPD treatment. In this narrative review the focus is on the function of endothelial inflammatory mediators [cytokines, chemokines, and cellular proteases] and pulmonary endothelial cells and endothelial dysfunction in COPD as well as the effects of dysfunction of the endothelium may play in COPD-related pulmonary hypertension. The relationship between smoking and endothelial dysfunction is also discussed. The connection between different pulmonary rehabilitation programs, arterial stiffness and pulse wave velocity (PWV) is presented. Endothelial dysfunction is a significant prognostic factor of COPD, which can be characterized by PWV. We discuss future considerations, like training programs, as an important part of the treatment that has a favorable impact on the endothelial function.

The use of near-infrared spectroscopy for the evaluation of a 4-week rehabilitation program in patients with COPD.

BACKGROUND: Near-infrared spectroscopy (NIRS) technology can evaluate muscle metabolism and oxygenation. NIRS-based oximeters can measure skeletal muscle oxygen delivery and utilization during static and dynamic work non-invasively. Our goal was to assess the value and usability of NIRS technology in chronic obstructive pulmonary disease (COPD) rehabilitation program. METHODS: Forty patients with COPD participated in a 4-week inpatient rehabilitation program that included breathing exercises and personalized cycle/treadmill training adjusted to the functional capacity, physical activity and comorbidities of the patients. A NIRS muscle oxygen monitor was used to measure tissue oxygenation and hemoglobin levels. Total hemoglobin index, average muscle oxygenation, minimal and maximal muscle oxygenation were recorded before and after the rehabilitation program. RESULTS: Rehabilitation resulted improvement in 6 min walking distance (6MWD:335.3 ± 110. vs. 398.3 ± 126.2 m; P < 0.01), maximal inspiratory pressure (MIP: 57.7 ± 22.7 vs. 63.6 ± 18.0 cmH2O; P < 0.01), chest wall expansion (CWE: 2.84 ± 1.26 vs, 4.00 ± 1.76 cm; P < 0.01), breath hold time (BHT: 25.8 ± 10.6 vs. 29.2 ± 11.6 s; P < 0.01) and grip strength (GS: 24.9 ± 11.9 vs. 27.0 ± 11.4 kg; P < 0.01). Quality of life improvement was monitored by COPD Assessment Test (CAT: 17.00 ± 8.49 vs. 11.89 ± 7.3, P < 0.05). Total hemoglobin index (tHb: 12.8 ± 1.3% vs. 12.8 ± 1.4), average muscle oxygenation (SmO2: 67.5 ± 14.4% vs. 65.2 ± 20.4%) showed a tendency for improvement. Maximal muscle oxygenation decreased (SmO2 max: 98.0 ± 20.5% vs. 90.1 ± 14.3%; P < 0.01). Minimal muscle oxygenation increased (SmO2 min: 42.6 ± 12.6% vs. 54.8 ± 14.3%; P < 0.01). CONCLUSIONS: NIRS results showed that muscle oxygenation and microcirculation can be described as a high-risk factor in COPD patients. The 4-week rehabilitation improves functional parameters, quality of life and tissue oxygenation levels in COPD patients.

Effectiveness of a 4-week rehabilitation program on endothelial function, blood vessel elasticity in patients with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) may have considerable cardiovascular risk. Physical activity has a paramount role in COPD treatment. Our aim was to evaluate the applicability of arteriograph in COPD and measure the effectiveness of pulmonary rehabilitation on endothelial function. METHODS: A total of 40 patients with COPD (FEV1: 45.43±20.20%pred, BMI: 27.99±6.98 kg/m2, male: female was 21:19, age: 65.47±7.39 years) participated in a 4-week rehabilitation program. We used a patented, invasively validated Arteriograph. Blood pressure, pulse, augmentation index (AIX), pulse wave velocity (PWV), diastolic area index (DAI) were registered with functional measurements in pulmonary rehabilitation. RESULTS: Pulmonary rehabilitation was effective in 6 minutes walking distance (6MWD: 335.32±110.43 vs. 398.32±126.21 m), maximal inspiratory pressure (MIP: 57.72±22.69 vs. 63.63±18.01 cmH2O), chest wall expansion (CWE: 2.84±1.26 vs. 4.00±1.76 cm), breath holding time (BHT: 25.77±10.63 to 29.21±11.60 sec) and grip strength (GS: 24.87±11.88 vs. 27.03±11.43 kg) (P<0.05). Improvement in quality of life was monitored by COPD assessment test marker (CAT: 17.00±8.49 vs. 11.89±7.31, P<0.05). Systolic (133.38±22.15 vs. 126.48±20.22 mmHg) and diastolic blood pressure (76.95±14.37 vs. 75.4±12.7 mmHg) showed a reduction tendency. Pulse also decreased (76.95±14.37 vs. 72.53±13.65 bpm). AIX levels showed slight improvement (3.54±35.59% vs. 2.93±30.79%); 23 patients peripheral circulation progressed. The PWV data showed abnormal elasticity with minimal change (11.74±2.13 vs. 11.4±2.73 m/s); although 20 patients showed improvement. DAI detected slightly diminished coronary circulation with moderate improvement (43.32±6.81 vs. 47.1±7.01 m/s). CONCLUSIONS: Elevated arterial stiffness, high PWV turned the COPD patients to the high/very high-risk cluster. Rehabilitation resulted significant improvement in MIP, CWE, BHT, 6MWD, CAT with mild, but favorable changes in blood pressure, pulse, AIX, PWV. As a consequence of the four weeks rehabilitation period overall quality of life improved and cardiovascular risk showed a reduction tendency in COPD.

Echocardiographic data in hungarian top-level water polo players.

PURPOSE: Water polo is a sport involving extremely intense exercise training that might be expected to result in major cardiac adaptations. The purpose of our study was to evaluate cardiac size, determine VO(2max) of top-level water polo players, and compare the findings with those of other top-level athletes. METHODS: Treadmill VO(2max) and 2D guided M-mode and Doppler echocardiographic data were obtained on players (N = 15) of the Olympic champion (Sydney 2000) Hungarian team and compared with data of Hungarian sedentary subjects (N = 19), and top-level endurance (N = 16) and power athletes (N = 15). RESULTS: Aerobic power of the water polo players was significantly lower (57.8 +/- 12.3 mL.min(-1).kg(-1)) than that of endurance athletes (70.9 +/- 8.9), higher than sedentary controls (49.7 +/- 4.3), and not different from that of power athletes (50.5 +/- 6.0). Body size related mean left ventricular wall thickness (LVWT/BSA(0.5)) was the highest in the water polo players (16.8 +/- 1.5 vs 15.9 +/- 1.1 in endurance, 14.5 +/- 1.0 in the power athletes, and 12.8 +/- 0.6 mm.m in nonathletes). Left ventricular muscle mass (LVMM/BSA(1.5)) was higher in the water polo players (115 +/- 22 g.m) than in power athletes (86 +/- 12) or nonathletes (74 +/- 9) and similar to that of endurance athletes (112 +/- 15). Resting heart rate was lower in the water polo players (55.1 +/- 9.7 beats.m(-1)) and endurance athletes (59.3 +/- 10.6) than in power athletes (66.0 +/- 16.1) or in sedentary subjects (72.9 +/- 10.9). CONCLUSIONS: Results indicate that high-level water polo results in marked cardiac hypertrophy that involves predominantly an increase of wall thickness, and in a VO(2max) lower than that of endurance athletes but similar to those of basketball and soccer players.

Relationship between relative aerobic power and echocardiographic characteristics in male athletes.

The relationship between relative aerobic power (rel.VO(2)max) as a generally accepted indicator of endurance capacity and certain characteristics of the athlete's heart, such as body-size related (relative) left ventricular (LV) diastolic wall thickness (WTd), internal diameter (LVIDd), muscle mass (MM), WTd/IDd, heart rate (HR), fractional shortening (FS) and E/A ratio, were investigated in 346 young males (18-35 years, 291 athletes of various events and 55 nonathletic control subjects). Rel.VO(2)max was measured by spiroergometry; cardiac characteristics were determined by two-dimensionally guided M-mode and Doppler-echocardiography. When the groups were pooled, correlation of rel.VO(2)max with the cardiac parameters was significant: LVMM.BSA(-1.5)= 0.413, LVWTd.BSA(-0.5)= 0.327, LVIDd.BSA(-0.5)= 0.292, HR =-0.434, E/A = 0.272 (P < 0.001), but no significant relationship was seen with FS and WTd/IDd. In the endurance trained group, rel. VO(2)max correlated significantly with LVMM.BSA(-1.5), LVWT.BSA(-0.5), HR, and E/A, in the ballgame players with LVMM.BSA(-1.5), LVWT.BSA(-0.5), and E/A, in the power-and-sprint event athletes with HR and E/A. In the control group, no significant relationship was observed. Results indicate that in athletes having higher endurance capacity maximal oxygen consumption depends largely on cardiac condition, while in athletes with a lower endurance capacity it can be limited by peripheral conditions.