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The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis

PURPOSE: Cystic fibrosis (CF) is commonly recognized as a pulmonary disease associated with reduced airway function. Another primary symptom of CF is low exercise capacity where ventilation and gas-exchange are exacerbated. However, an independent link between pathophysiology of the pulmonary system...

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Autores principales: Van Iterson, Erik H., Wheatley, Courtney M., Baker, Sarah E., Olson, Thomas P., Morgan, Wayne J., Snyder, Eric M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5172623/
https://www.ncbi.nlm.nih.gov/pubmed/27997623
http://dx.doi.org/10.1371/journal.pone.0168490
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author Van Iterson, Erik H.
Wheatley, Courtney M.
Baker, Sarah E.
Olson, Thomas P.
Morgan, Wayne J.
Snyder, Eric M.
author_facet Van Iterson, Erik H.
Wheatley, Courtney M.
Baker, Sarah E.
Olson, Thomas P.
Morgan, Wayne J.
Snyder, Eric M.
author_sort Van Iterson, Erik H.
collection PubMed
description PURPOSE: Cystic fibrosis (CF) is commonly recognized as a pulmonary disease associated with reduced airway function. Another primary symptom of CF is low exercise capacity where ventilation and gas-exchange are exacerbated. However, an independent link between pathophysiology of the pulmonary system and abnormal ventilatory and gas-exchange responses during cardiopulmonary exercise testing (CPET) has not been established in CF. Complicating this understanding, accumulating evidence suggests CF demonstrate abnormal peripheral vascular function; although, the clinical implications are unclear. We hypothesized that compared to controls, relative to total work performed (Work(TOT)), CF would demonstrate increased ventilation accompanied by augmented systolic blood pressure (SBP) during CPET. METHODS: 16 CF and 23 controls (age: 23±4 vs. 27±4 years, P = 0.11; FEV(1)%predicted: 73±14 vs. 96±5, P<0.01) participated in CPET. Breath-by-breath oxygen uptake ([Image: see text] ), ventilation ([Image: see text] ), and carbon dioxide output ([Image: see text] ) were measured continuously during incremental 3-min stage step-wise cycle ergometry CPET. SBP was measured via manual sphygmomanometry. Linear regression was used to calculate [Image: see text] slope from rest to peak-exercise. RESULTS: Compared to controls, CF performed less Work(TOT) during CPET (90±19 vs. 43±14 kJ, respectively, P<0.01). With Work(TOT) as a covariate, peak [Image: see text] (62±8 vs. 90±4 L/min, P = 0.76), [Image: see text] (1.8±0.3 vs. 2.7±0.1 L/min, P = 0.40), and SBP (144±13 vs. 152±6 mmHg, P = 0.88) were similar between CF and controls, respectively; whereas CF demonstrated increased [Image: see text] slope (38±4 vs. 28±2, P = 0.02) but lower peak [Image: see text] versus controls (22±5 vs. 33±4 mL/kg/min, P<0.01). There were modest-to-moderate correlations between peak SBP with [Image: see text] (r = 0.30), [Image: see text] (r = 0.70), and [Image: see text] (r = 0.62) in CF. CONCLUSIONS: These data suggest that relative to Work(TOT), young adults with mild-to-moderate severity CF demonstrate augmented [Image: see text] slope accompanied by increased SBP during CPET. Although the underlying mechanisms remain unclear, the coupling of ventilatory inefficiency with increased blood pressure suggest important contributions from peripheral pathophysiology to low exercise capacity in CF.
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spelling pubmed-51726232017-01-04 The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis Van Iterson, Erik H. Wheatley, Courtney M. Baker, Sarah E. Olson, Thomas P. Morgan, Wayne J. Snyder, Eric M. PLoS One Research Article PURPOSE: Cystic fibrosis (CF) is commonly recognized as a pulmonary disease associated with reduced airway function. Another primary symptom of CF is low exercise capacity where ventilation and gas-exchange are exacerbated. However, an independent link between pathophysiology of the pulmonary system and abnormal ventilatory and gas-exchange responses during cardiopulmonary exercise testing (CPET) has not been established in CF. Complicating this understanding, accumulating evidence suggests CF demonstrate abnormal peripheral vascular function; although, the clinical implications are unclear. We hypothesized that compared to controls, relative to total work performed (Work(TOT)), CF would demonstrate increased ventilation accompanied by augmented systolic blood pressure (SBP) during CPET. METHODS: 16 CF and 23 controls (age: 23±4 vs. 27±4 years, P = 0.11; FEV(1)%predicted: 73±14 vs. 96±5, P<0.01) participated in CPET. Breath-by-breath oxygen uptake ([Image: see text] ), ventilation ([Image: see text] ), and carbon dioxide output ([Image: see text] ) were measured continuously during incremental 3-min stage step-wise cycle ergometry CPET. SBP was measured via manual sphygmomanometry. Linear regression was used to calculate [Image: see text] slope from rest to peak-exercise. RESULTS: Compared to controls, CF performed less Work(TOT) during CPET (90±19 vs. 43±14 kJ, respectively, P<0.01). With Work(TOT) as a covariate, peak [Image: see text] (62±8 vs. 90±4 L/min, P = 0.76), [Image: see text] (1.8±0.3 vs. 2.7±0.1 L/min, P = 0.40), and SBP (144±13 vs. 152±6 mmHg, P = 0.88) were similar between CF and controls, respectively; whereas CF demonstrated increased [Image: see text] slope (38±4 vs. 28±2, P = 0.02) but lower peak [Image: see text] versus controls (22±5 vs. 33±4 mL/kg/min, P<0.01). There were modest-to-moderate correlations between peak SBP with [Image: see text] (r = 0.30), [Image: see text] (r = 0.70), and [Image: see text] (r = 0.62) in CF. CONCLUSIONS: These data suggest that relative to Work(TOT), young adults with mild-to-moderate severity CF demonstrate augmented [Image: see text] slope accompanied by increased SBP during CPET. Although the underlying mechanisms remain unclear, the coupling of ventilatory inefficiency with increased blood pressure suggest important contributions from peripheral pathophysiology to low exercise capacity in CF. Public Library of Science 2016-12-20 /pmc/articles/PMC5172623/ /pubmed/27997623 http://dx.doi.org/10.1371/journal.pone.0168490 Text en © 2016 Van Iterson et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Van Iterson, Erik H.
Wheatley, Courtney M.
Baker, Sarah E.
Olson, Thomas P.
Morgan, Wayne J.
Snyder, Eric M.
The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis
title The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis
title_full The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis
title_fullStr The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis
title_full_unstemmed The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis
title_short The Coupling of Peripheral Blood Pressure and Ventilatory Responses during Exercise in Young Adults with Cystic Fibrosis
title_sort coupling of peripheral blood pressure and ventilatory responses during exercise in young adults with cystic fibrosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5172623/
https://www.ncbi.nlm.nih.gov/pubmed/27997623
http://dx.doi.org/10.1371/journal.pone.0168490
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