Neuromuscular Fatigue During Exercise in COPD-HF Overlap

University Hospital, Grenoble40 enrolled

Overview

Rationale. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) coexist in approximately one third of patients presenting with one of these conditions. From a clinical standpoint, impaired tissue oxygen (O2) delivery stands as a common pathological mechanism of these cardiorespiratory diseases. Recent evidence suggest that muscle and cerebral blood flow and oxygenation are further impaired during exercise in patients with COPD-HF overlap compared to isolated diseases. However, it remains unknown whether impaired O2 delivery is associated with exaggerated manifestations of peripheral and central fatigue in COPD-HF overlap. In addition, improving cardiopulmonary interactions through non invasive positive pressure ventilation or through the addition of a hyperoxic gas mixture during exercise have been associated with enhanced cerebral and muscle O2 delivery and oxygenation in patients with COPD or HF. It is, therefore, conceivable that improved O2 delivery to these structures have beneficial influence on exercise capacity in patients with COPD-HF overlap due to less peripheral and central fatigue. Aims. To investigate the influence of impaired O2 delivery during exercise, and its alleviation with different interventions (non invasive positive pressure ventilation or hyperoxia), on neuromuscular fatigue in patients with COPD-HF.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Pulmonary Disease, Chronic Obstructive

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 18 years; * COPD: mild-to-severe airflow obstruction (forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio \<0.70; post-bronchodilator FEV1 \> 30% predicted); * HF: reduced left ventricular ejection fraction (\<50%, for COPD-HF patients only); * HF: New York Heart Association Functional Classification I to III (for COPD-HF patients only); * Clinical stability for both diseases (COPD and/or HF) and no recent (within 3 months) exacerbation requiring a change in medications; * Patient benefiting from health care coverage; * Patient able to provide written informed consent. Exclusion Criteria: * Inability to perform cycle ergometry; * Medical device incompatible with magnetic stimulation; * Counter-indication to perform exercise test; * Patient refusing to sign written informed consent; * Patient not benefiting from health care coverage; * Patient exceeding the annual ceiling of authorized compensation received following participation to a clinical trial; * Patient deprived of freedom by judicial or administrative decision; * Patient subject to a measure of legal protection (safeguard of justice, guardianship, curatorship), who cannot be included in clinical trials; * Pregnant or nursing woman.

Outcomes

Primary Outcomes

Muscle fatigue

Muscle fatigue assessed by magnetic stimulation of the femoral nerve

Time frame: Muscle fatigue assessed immediately after exercise, between-group (COPD vs COPD-HF under medical air) and within-group (medical air vs intervention trial in COPD-HF) comparisons

Secondary Outcomes

Exertional symptoms

Symptoms of dyspnea, leg discomfort, and fatigue

Time frame: Symptoms during exercise, between-group (COPD vs COPD-HF under medical air) and within-group (medical air vs intervention trial in COPD-HF) comparisons

Tissue oxygenation

Prefrontal and quadriceps oxygenation (near-infrared spectroscopy)

Time frame: Tissue oxygenation during exercise, between-group (COPD vs COPD-HF under medical air) and within-group (medical air vs intervention trial in COPD-HF) comparisons

Cerebral blood flow

Middle cerebral artery blood flow velocity (transcranial Doppler ultrasonography)

Time frame: Cerebral blood flow during exercise, between-group (COPD vs COPD-HF under medical air) and within-group (medical air vs intervention trial in COPD-HF) comparisons

Cardiac output

Cardiac output (signal-morphology impedance cardiography)

Time frame: Cardiac output during exercise, between-group (COPD vs COPD-HF under medical air) and within-group (medical air vs intervention trial in COPD-HF) comparisons