Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease

Andreas Scherr,Meropi Karakioulaki,Michael Zellweger,Michael Tamm,Desiree M Schumann,Daiana Stolz,Léo Franchetti,Werner Strobel

doi:10.1186/s12931-020-01345-9

Abstract

BackgroundLocal airway inflammation may cause systemic changes which result in endothelial dysfunction. Only a few studies have used reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with chronic obstructive pulmonary disease (COPD) in order to measure their endothelial dysfunction.ObjectiveTo determine the efficacy of endothelial dysfunction, measured by RH-PAT, in assessing disease severity and systemic burden in a cohort of COPD patients.MethodsIn this prospective, monocentric study, 157 patients with moderate to very severe COPD (GOLD class II-IV) were examined for endothelial dysfunction using RH-PAT (Itamar medical Ltd., Caesarea, Israel). In a nested-cohort, examination was repeated at exacerbation. The association between reactive hyperemia index (RHI), augmentation index (AI) and disease severity and outcome parameters was analysed.Results57% of the COPD patients had a dysfunctional endothelium and the median (IQR) RHI was 1.42 (1.27–1.53). Exacerbation of COPD was not associated with a significant change in RHI (p = 0.625) or ΑΙ (p = 0.530). None of the diagnostic or clinical outcomes of COPD was associated with RHI or arterial stiffness.ConclusionEndothelial dysfunction is common in COPD. However, it does not seem to be a predictor neither of disease severity, nor of outcome and does not change during exacerbations of the disease.

Highlights

Local airway inflammation may cause systemic changes which result in endothelial dysfunction
The median (IQR) reactive hyperemia index (RHI) score was 1.42 (1.27–1.53) and none of the diagnostic or clinical outcomes of chronic obstructive pulmonary disease (COPD) was associated with the RHI or arterial stiffness (Table 2)
BMI Body mass index, 6-min walking distance (6MWD) 6-min walk distance, COPD assessment test (CAT) score COPD assessment score, brd bronchodilator, FEV1 Forced expiratory volume in 1 s., FVC Forced vital capacity, BODE BMI, airflow obstruction, dyspnoea and exercise capacity, GOLD Gold Initiative for Chronic Obstructive Lung Disease, GOLD grades are based on FEV1% predicted: 50% ≤ II ≤ 80%; 30% ≤ III ≤ 50%; and IV ≤ 30%, mMRC Modified Medical Research Council Dyspnoea scale, St. George’s respiratory questionnaire (SGRQ) St

Summary

Introduction

Local airway inflammation may cause systemic changes which result in endothelial dysfunction. A few studies have used reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with chronic obstructive pulmonary disease (COPD) in order to measure their endothelial dysfunction. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide [1,2,3]. It is associated with extrapulmonary comorbid conditions, such as peripheral vascular disease, osteoporosis, skeletal muscle dysfunction, reduced exercise capacity, erectile dysfunction, Scherr et al Respiratory Research (2020) 21:90 mediated changes in the structure of the vessel walls, such as the replacement of degraded elastic fibres by collagen, which increases arterial stiffness [8]. Abnormal RH-PAT results are correlated with ischemic heart disease diagnosed using an invasive method [18]

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Conclusion