Lung deflation and oxygen pulse in COPD: Results from the NETT randomized trial

Background: In COPD patients, hyperinflation impairs cardiac function. We examined whether lung deflation improves oxygen pulse, a surrogate marker of stroke volume. Methods: In 129 NETT patients with cardiopulmonary exercise testing (CPET) and arterial blood gases (ABG substudy), hyperinflation was assessed with residual volume to total lung capacity ratio (RV/TLC), and cardiac function with oxygen pulse (O(2) pulse = VO(2)/HR) at baseline and 6 months. Medical and surgical patients were divided into deflators and non-deflators based on change in RV/TLC from baseline (Delta RV/TLC). We defined deflation as the Delta RV/TLC experienced by 75% of surgical patients. We examined changes in O(2) pulse at peak and similar (iso-work) exercise. Findings were validated in 718 patients who underwent CPET without ABGs. Results: In the ABG substudy, surgical and medical deflators improved their RV/TLC and peak O(2) pulse (median Delta RV/TLC -18.0% vs. -9.3%, p = 0.0003; median Delta O(2) pulse 13.6% vs. 1.8%, p = 0.12). Surgical deflators also improved iso-work O(2) pulse (0.53 mL/beat, p = 0.04 at 20 W). In the validation cohort, surgical deflators experienced a greater improvement in peak 02 pulse than medical deflators (mean 18.9% vs. 1.1%). In surgical deflators improvements in O(2) pulse at rest and during unloaded pedaling (0.32 mL/beat, p < 0.0001 and 0.47 mL/beat, p < 0.0001, respectively) corresponded with significant reductions in HR and improvements in VO(2). On multivariate analysis, deflators were 88% more likely than non-deflators to have an improvement in O(2) pulse (OR 1.88, 95% CI 1.30-2.72, p = 0.0008). Conclusion: In COPD, decreased hyperinflation through lung volume reduction is associated with improved O(2) pulse. (C) 2011 Elsevier Ltd. All rights reserved.