Ventilatory and Cardiocirculatory Exercise Profiles in COPD The Role of Pulmonary Hypertension

Background: Pulmonary hypertension (PH) is a well-recognized complication of COPD. The impact of PH on exercise tolerance is largely unknown. We evaluated and compared the circulatory and ventilatory profiles during exercise in patients with COPD without PH, with moderate PH, and with severe PH. Methods: Forty-seven patients, GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages II to IV, underwent cardiopulmonary exercise testing and right-sided heart catheterization at rest and during exercise. Patients were divided into three groups based on mean pulmonary artery pressure (mPAP) at rest: no PH (mPAP, <25 mm Hg), moderate PH (mPAP, 25-39 mm Hg), and severe PH (mPAP, >= 40 mm Hg). Mixed venous oxygen saturation (Svo(2)) was used for evaluating the circulatory reserve. Paco(2) and the calculated breathing reserve were used for evaluation of the ventilatory reserve. Results: Patients without PH (n = 24) had an end-exercise Svo(2) of 48% +/- 9%, an increasing Paco(2) with exercise, and a breathing reserve of 22% +/- 20%. Patients with moderate PH (n = 14) had an exercise Svo(2) of 40% +/- 8%, an increasing Paco(2) and a breathing reserve of 26% +/- 15%. Patients with severe PH (n = 9) had a significantly lower end-exercise Svo(2) (30% +/- 6%), a breathing reserve of 37% +/- 11%, and an absence of Paco(2) accumulation. Conclusion: Patients with severe PH showed an exhausted circulatory reserve at the end of exercise. A profile of circulatory reserve in combination with ventilatory impairments was found in patients with COPD and moderate or no PH. The results suggest that pulmonary vasodilation might only improve exercise tolerance in patients with COPD and severe PH. CHEST 2012; 142(5):1166-1174