Exacerbation of COPD and COPD overlap heart failure and noninvasive ventilatory support: impact on endothelial function and cardiac autonomic modulation and relationship among cardiovascular outcomes and clinical and functional aspects

Abstract

In chronic obstructive pulmonary disease (COPD), periods of exacerbations are frequent and associated with hospitalizations, reduced functional capacity, and risk for cardiovascular disease. The impairment of endothelial function (EF) and cardiac autonomic modulation (CAM) in this population has been previously demonstrated, however, the coexistence of COPD and chronic heart failure (HF) is high, and the impact of this overlapping, as well as the influence of factors clinical and functional exacerbation, still lacks evidence. Additionally, it is known that the noninvasive ventilatory support (NIV) is beneficial in COPD and HF exacerbations evaluated on the optical of several outcomes, however, for these cardiovascular outcomes proposed and in the coexistence of diseases, the impact of NIV lacks scientific basis. Objective: To investigate the impact of the coexistence of COPD + HF and the effect of NIV on the FE and MAC, as well as the existence of a relationship of these outcomes with clinical and functional in the exacerbation stage. Design and methodology: Prospective longitudinal and interventional study with comparative control. The study population will consist of 32 individuals diagnosed with isolated COPD (GDPOC, n=16) or associated with HF (GDPIC, n=16). The assessment will include measures of the main outcomes of FE by flow-mediated vasodilation of the brachial artery and arterial stiffness and MAC by heart rate variability (HRV), an assessment of the quality of life, functional capacity and cognitive and laboratory tests in three distinct stages: (1). Acute condition (24-48 hours of exacerbation) pre-intervention with NIV; (2). The post-intervention acute condition with NIV and (3). Chronic condition: 30 days after the first evaluation. NIV will be provided in the bilevel mode for at least 30 minutes and maximal 1 hour. The hypothesis for this study is that endothelial and cardiac autonomic function will be more impaired in overlap patients when compared to isolated COPD patients and that the application of NIV in this exacerbation phase will result in acute beneficial responses to endothelial and cardiac autonomic function. Another hypothesis is the existence of an association of cardiovascular outcomes among themselves as well as with clinical and functional aspects. This new knowledge will contribute to future interventional proposals to the most appropriate management of these diseases that represent significant causes of disability and mortality worldwide with an increasing trend due to an aging population. (AU)