Arterial stiffness and endothelial dysfunction in patients with chronic obstructive pulmonary disease: what is primary and secondary?

Abstract

SummaryThe aim of this study was to investigate relationship between arterial stiffness and endothelial dysfunction, on one hand, and clinical ad functional parameters of chronic obstructive pulmonary disease (COPD), on the other hand. This was a prospective cross sectional comparative study. Arterial stiffness was measured using photoplethysmography (Pulse Trace PCA 2, Micro Medical). We calculated stiffness index (SI) which reflected pulse wave velocity in large arteries, and reflectance index (RI) which is generally related to small vessel tone. Endothelial dysfunction was assessed with RI changes (Δ RISLB) before and after inhalation of salbutamol and also according to serum endothelin 1. The study involved 41 patients with COPD (mean age, 64.5 ± 7.6 yrs; FEV1, 37.7 ± 14.1 %; РаО2, 63.2 ± 11.2 mm Hg). SI was 11.3 ± 3.3 m / s; RI was 69.1 ± 16.6 % in comparison to 6.9 ± 0.9 m / s and 53.6 ± 14.7 %, respectively, in controls (р < 0.05). In COPD patients, Δ RISLB was signif icantly lower compared to controls (1.15 [0 10] % vs 11.50 [6-19] %; р < 0.05). As severity of COPD increased, Δ RISLB decreased (р < 0.05). Serum endothelin 1 in COPD patients was higher than normal level (0.47 [0.23-0.71] vs 0.26 fmol / ml; р < 0.05). Serum endothelin 1 was inverse ly related to RI (R = 0.44; р = 0.02) and Δ RISLB (R = -0.46; р = 0.03). A significant correlation was also found between the indexes and clinical and functional parameters (BMI, RV, DLCO, FEV1, heart beat rate, breathing rate, dyspnea assessment using MRC scale), 6 min walking distance. Therefore, arterial stiffness was significantly higher in COPD patients compared to patients with asthma and healthy volunteers. Increase in arteri al stiffness is linearly related to severity of the disease. Endothelial dysfunction in COPD patients was significantly higher compared to that in com parative groups and was related to arterial stiffness.

Scientific research of the Federal Pulmonology Research Institute and its role for improvement of respiratory care quality in Russia

“…Установлено, что при сочетании БОД с болезня ми системы кровообращения увеличивается тяжесть состояния больного, что вносит изменения в лече ние. Неинвазивная оценка эндотелиальной функ ции и артериальной ригидности открывает реальные перспективы ранней диагностики сердечно сосу дистого риска у больных ХОБЛ, при этом надежным методом измерения структурно функционального состояния стенок артерий у больных ХОБЛ, прием лемым для использования в широкой амбулаторной практике, является контурный анализ пульсовой волны [47].…”

The Peculiarities of the Change of the Endothelial Function in the Patients With Chronic Obstructive Pulmonary Disease in Conditions of Its Comorbidity With Essential Hypertension

“…Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases, first of all, essential hypertension (EHT) are leaders both in the structure of morbidity and mortality among pathology of internal organs [2,4,6], especially in cases of their combination [9]. Nowadays, the change of the functional state of endothelium in the patients with COPD and EHT is considered as one of the key mechanisms in pathogenesis of these diseases [7,11,8,10] and is a possible connecting link between bronchopulmonary pathology and cardiovascular diseases [3]. The foregoing and also a frequent combination of COPD and EHT in the clinic of internal diseases [1] were a precondition for carrying out this study.…”

Markers of Systemic Inflammation and Endothelial Dysfunction in Patients With Chronic Obstructive Pulmonary Disease

“…Артериография -метод оценки эндотелиальной дисфункции Одним из методов, способных оценить эндотелиальную дисфункцию, является метод определения артериальной ригидности [8]. Увеличение ригидности артерий рекомендуется относить к доклиническим признакам поражения органовмишеней наряду с традиционными клиническими [3].…”