Lung Deflation and Cardiovascular Structure and Function in Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial
Patients with chronic obstructive pulmonary disease develop increased cardiovascular morbidity with structural alterations. To investigate through a double-blind, placebo-controlled, crossover study the effect of lung deflation on cardiovascular structure and function using cardiac magnetic resonanc...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2016-04, Vol.193 (7), p.717-726 |
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| creator | Stone, Ian S Barnes, Neil C James, Wai-Yee Midwinter, Dawn Boubertakh, Redha Follows, Richard John, Leonette Petersen, Steffen E |
| description | Patients with chronic obstructive pulmonary disease develop increased cardiovascular morbidity with structural alterations.
To investigate through a double-blind, placebo-controlled, crossover study the effect of lung deflation on cardiovascular structure and function using cardiac magnetic resonance.
Forty-five hyperinflated patients with chronic obstructive pulmonary disease were randomized (1:1) to 7 (maximum 14) days inhaled corticosteroid/long-acting β2-agonist fluticasone furoate/vilanterol 100/25 μg or placebo (7-day minimum washout). Primary outcome was change from baseline in right ventricular end-diastolic volume index versus placebo.
There was a 5.8 ml/m(2) (95% confidence interval, 2.74-8.91; P |
| doi_str_mv | 10.1164/rccm.201508-1647OC |
| format | Article |
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To investigate through a double-blind, placebo-controlled, crossover study the effect of lung deflation on cardiovascular structure and function using cardiac magnetic resonance.
Forty-five hyperinflated patients with chronic obstructive pulmonary disease were randomized (1:1) to 7 (maximum 14) days inhaled corticosteroid/long-acting β2-agonist fluticasone furoate/vilanterol 100/25 μg or placebo (7-day minimum washout). Primary outcome was change from baseline in right ventricular end-diastolic volume index versus placebo.
There was a 5.8 ml/m(2) (95% confidence interval, 2.74-8.91; P < 0.001) increase in change from baseline right ventricular end-diastolic volume index and a 429 ml (P < 0.001) reduction in residual volume with fluticasone furoate/vilanterol versus placebo. Left ventricular end-diastolic and left atrial end-systolic volumes increased by 3.63 ml/m(2) (P = 0.002) and 2.33 ml/m(2) (P = 0.002). In post hoc analysis, right ventricular stroke volume increased by 4.87 ml/m(2) (P = 0.003); right ventricular ejection fraction was unchanged. Left ventricular adaptation was similar; left atrial ejection fraction improved by +3.17% (P < 0.001). Intrinsic myocardial function was unchanged. Pulmonary artery pulsatility increased in two of three locations (main +2.9%, P = 0.001; left +2.67%, P = 0.030). Fluticasone furoate/vilanterol safety profile was similar to placebo.
Pharmacologic treatment of chronic obstructive pulmonary disease has consistent beneficial and plausible effects on cardiac function and pulmonary vasculature that may contribute to favorable effects of inhaled therapies. Future studies should investigate the effect of prolonged lung deflation on intrinsic myocardial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01691885).</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201508-1647OC</identifier><identifier>PMID: 26550687</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject><![CDATA[Administration, Inhalation ; Adrenal Cortex Hormones - administration & dosage ; Adrenergic beta-2 Receptor Agonists - administration & dosage ; Aged ; Androstadienes - administration & dosage ; Benzyl Alcohols - administration & dosage ; Bronchodilator Agents - administration & dosage ; Chlorobenzenes - administration & dosage ; Cross-Over Studies ; Drug Combinations ; Female ; Forced Expiratory Volume - drug effects ; Heart - drug effects ; Heart - physiopathology ; Humans ; Lung - drug effects ; Lung - pathology ; Lung - physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myocardium - pathology ; Original ; Pulmonary Disease, Chronic Obstructive - complications ; Pulmonary Disease, Chronic Obstructive - drug therapy ; Pulmonary Disease, Chronic Obstructive - physiopathology]]></subject><ispartof>American journal of respiratory and critical care medicine, 2016-04, Vol.193 (7), p.717-726</ispartof><rights>Copyright American Thoracic Society Apr 1, 2016</rights><rights>Copyright © 2016 by the American Thoracic Society 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-1e013e1f1c727062bd0f30baf17443f9c6702fde7c7ec637384b6be158a7f31b3</citedby><cites>FETCH-LOGICAL-c430t-1e013e1f1c727062bd0f30baf17443f9c6702fde7c7ec637384b6be158a7f31b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4011,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26550687$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stone, Ian S</creatorcontrib><creatorcontrib>Barnes, Neil C</creatorcontrib><creatorcontrib>James, Wai-Yee</creatorcontrib><creatorcontrib>Midwinter, Dawn</creatorcontrib><creatorcontrib>Boubertakh, Redha</creatorcontrib><creatorcontrib>Follows, Richard</creatorcontrib><creatorcontrib>John, Leonette</creatorcontrib><creatorcontrib>Petersen, Steffen E</creatorcontrib><title>Lung Deflation and Cardiovascular Structure and Function in Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>Patients with chronic obstructive pulmonary disease develop increased cardiovascular morbidity with structural alterations.
To investigate through a double-blind, placebo-controlled, crossover study the effect of lung deflation on cardiovascular structure and function using cardiac magnetic resonance.
Forty-five hyperinflated patients with chronic obstructive pulmonary disease were randomized (1:1) to 7 (maximum 14) days inhaled corticosteroid/long-acting β2-agonist fluticasone furoate/vilanterol 100/25 μg or placebo (7-day minimum washout). Primary outcome was change from baseline in right ventricular end-diastolic volume index versus placebo.
There was a 5.8 ml/m(2) (95% confidence interval, 2.74-8.91; P < 0.001) increase in change from baseline right ventricular end-diastolic volume index and a 429 ml (P < 0.001) reduction in residual volume with fluticasone furoate/vilanterol versus placebo. Left ventricular end-diastolic and left atrial end-systolic volumes increased by 3.63 ml/m(2) (P = 0.002) and 2.33 ml/m(2) (P = 0.002). In post hoc analysis, right ventricular stroke volume increased by 4.87 ml/m(2) (P = 0.003); right ventricular ejection fraction was unchanged. Left ventricular adaptation was similar; left atrial ejection fraction improved by +3.17% (P < 0.001). Intrinsic myocardial function was unchanged. Pulmonary artery pulsatility increased in two of three locations (main +2.9%, P = 0.001; left +2.67%, P = 0.030). Fluticasone furoate/vilanterol safety profile was similar to placebo.
Pharmacologic treatment of chronic obstructive pulmonary disease has consistent beneficial and plausible effects on cardiac function and pulmonary vasculature that may contribute to favorable effects of inhaled therapies. Future studies should investigate the effect of prolonged lung deflation on intrinsic myocardial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01691885).</description><subject>Administration, Inhalation</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenergic beta-2 Receptor Agonists - administration & dosage</subject><subject>Aged</subject><subject>Androstadienes - administration & dosage</subject><subject>Benzyl Alcohols - administration & dosage</subject><subject>Bronchodilator Agents - administration & dosage</subject><subject>Chlorobenzenes - administration & dosage</subject><subject>Cross-Over Studies</subject><subject>Drug Combinations</subject><subject>Female</subject><subject>Forced Expiratory Volume - drug effects</subject><subject>Heart - drug effects</subject><subject>Heart - physiopathology</subject><subject>Humans</subject><subject>Lung - drug effects</subject><subject>Lung - pathology</subject><subject>Lung - physiopathology</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Original</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Pulmonary Disease, Chronic Obstructive - drug therapy</subject><subject>Pulmonary Disease, Chronic Obstructive - physiopathology</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkVFrFDEUhYMotq7-AR8k4EtfZs2dZCYzL0KZWhUWVrSCbyGTSdqUTFKTyYI--dPN7taiPuWG-53DuRyEXgJZA7TsTVRqXtcEGtJV5c-3wyN0Cg1tKtZz8rjMhNOKsf7bCXqW0i0hUHdAnqKTum0a0nb8FP3aZH-NL7RxcrHBY-knPMg42bCTSWUnI_6yxKyWHPVheZm9OpDW4-EmBm8V3o7pwNidxp-ym4OX8Qe-sEnLpNf4HH8uyjDbn7qYB7_E4FwZr6KV7jl6YqRL-sX9u0JfL99dDR-qzfb9x-F8UylGyVKBJkA1GFC85qStx4kYSkZpgDNGTa9aTmozaa64Vi3ltGNjO2poOskNhZGu0Nuj710eZz0pXWJIJ-6inUtYEaQV_268vRHXYScaxgjpoRic3RvE8D3rtIjZJqWdk16HnARwzvuu4aWAFXr9H3obcvTlvD3V94xCvafqI6ViSClq8xAGiNgXLPYFi2PB4lhwEb36-4wHyZ9G6W8A2qTl</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Stone, Ian S</creator><creator>Barnes, Neil C</creator><creator>James, Wai-Yee</creator><creator>Midwinter, Dawn</creator><creator>Boubertakh, Redha</creator><creator>Follows, Richard</creator><creator>John, Leonette</creator><creator>Petersen, Steffen E</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160401</creationdate><title>Lung Deflation and Cardiovascular Structure and Function in Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial</title><author>Stone, Ian S ; Barnes, Neil C ; James, Wai-Yee ; Midwinter, Dawn ; Boubertakh, Redha ; Follows, Richard ; John, Leonette ; Petersen, Steffen E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c430t-1e013e1f1c727062bd0f30baf17443f9c6702fde7c7ec637384b6be158a7f31b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Administration, Inhalation</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenergic beta-2 Receptor Agonists - administration & dosage</topic><topic>Aged</topic><topic>Androstadienes - administration & dosage</topic><topic>Benzyl Alcohols - administration & dosage</topic><topic>Bronchodilator Agents - administration & dosage</topic><topic>Chlorobenzenes - administration & dosage</topic><topic>Cross-Over Studies</topic><topic>Drug Combinations</topic><topic>Female</topic><topic>Forced Expiratory Volume - drug effects</topic><topic>Heart - drug effects</topic><topic>Heart - physiopathology</topic><topic>Humans</topic><topic>Lung - drug effects</topic><topic>Lung - pathology</topic><topic>Lung - physiopathology</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardium - pathology</topic><topic>Original</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Pulmonary Disease, Chronic Obstructive - drug therapy</topic><topic>Pulmonary Disease, Chronic Obstructive - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stone, Ian S</creatorcontrib><creatorcontrib>Barnes, Neil C</creatorcontrib><creatorcontrib>James, Wai-Yee</creatorcontrib><creatorcontrib>Midwinter, Dawn</creatorcontrib><creatorcontrib>Boubertakh, Redha</creatorcontrib><creatorcontrib>Follows, Richard</creatorcontrib><creatorcontrib>John, Leonette</creatorcontrib><creatorcontrib>Petersen, Steffen E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stone, Ian S</au><au>Barnes, Neil C</au><au>James, Wai-Yee</au><au>Midwinter, Dawn</au><au>Boubertakh, Redha</au><au>Follows, Richard</au><au>John, Leonette</au><au>Petersen, Steffen E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lung Deflation and Cardiovascular Structure and Function in Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>193</volume><issue>7</issue><spage>717</spage><epage>726</epage><pages>717-726</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>Patients with chronic obstructive pulmonary disease develop increased cardiovascular morbidity with structural alterations.
To investigate through a double-blind, placebo-controlled, crossover study the effect of lung deflation on cardiovascular structure and function using cardiac magnetic resonance.
Forty-five hyperinflated patients with chronic obstructive pulmonary disease were randomized (1:1) to 7 (maximum 14) days inhaled corticosteroid/long-acting β2-agonist fluticasone furoate/vilanterol 100/25 μg or placebo (7-day minimum washout). Primary outcome was change from baseline in right ventricular end-diastolic volume index versus placebo.
There was a 5.8 ml/m(2) (95% confidence interval, 2.74-8.91; P < 0.001) increase in change from baseline right ventricular end-diastolic volume index and a 429 ml (P < 0.001) reduction in residual volume with fluticasone furoate/vilanterol versus placebo. Left ventricular end-diastolic and left atrial end-systolic volumes increased by 3.63 ml/m(2) (P = 0.002) and 2.33 ml/m(2) (P = 0.002). In post hoc analysis, right ventricular stroke volume increased by 4.87 ml/m(2) (P = 0.003); right ventricular ejection fraction was unchanged. Left ventricular adaptation was similar; left atrial ejection fraction improved by +3.17% (P < 0.001). Intrinsic myocardial function was unchanged. Pulmonary artery pulsatility increased in two of three locations (main +2.9%, P = 0.001; left +2.67%, P = 0.030). Fluticasone furoate/vilanterol safety profile was similar to placebo.
Pharmacologic treatment of chronic obstructive pulmonary disease has consistent beneficial and plausible effects on cardiac function and pulmonary vasculature that may contribute to favorable effects of inhaled therapies. Future studies should investigate the effect of prolonged lung deflation on intrinsic myocardial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01691885).</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>26550687</pmid><doi>10.1164/rccm.201508-1647OC</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2016-04, Vol.193 (7), p.717-726 |
| issn | 1073-449X 1535-4970 |
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| source | MEDLINE; American Thoracic Society (ATS) Journals Online; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Administration, Inhalation Adrenal Cortex Hormones - administration & dosage Adrenergic beta-2 Receptor Agonists - administration & dosage Aged Androstadienes - administration & dosage Benzyl Alcohols - administration & dosage Bronchodilator Agents - administration & dosage Chlorobenzenes - administration & dosage Cross-Over Studies Drug Combinations Female Forced Expiratory Volume - drug effects Heart - drug effects Heart - physiopathology Humans Lung - drug effects Lung - pathology Lung - physiopathology Magnetic Resonance Imaging Male Middle Aged Myocardium - pathology Original Pulmonary Disease, Chronic Obstructive - complications Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - physiopathology |
| title | Lung Deflation and Cardiovascular Structure and Function in Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial |
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