Impaired Spontaneous Baroreceptor Reflex Sensitivity in Patients With COPD Compared to Healthy Controls: The Role of Lung Hyperinflation

Anna Katharina Mayr; Victoria Wieser; Georg-Christian Funk; Sherwin Asadi; Irene Sperk; Matthias Helmut Urban; Arschang Valipour

doi:10.3389/fmed.2021.791410

Impaired Spontaneous Baroreceptor Reflex Sensitivity in Patients With COPD Compared to Healthy Controls: The Role of Lung Hyperinflation

Front Med (Lausanne). 2022 Jan 3:8:791410. doi: 10.3389/fmed.2021.791410. eCollection 2021.

Authors

Anna Katharina Mayr^{1

2}, Victoria Wieser³, Georg-Christian Funk^{1

4}, Sherwin Asadi⁵, Irene Sperk^{1

2}, Matthias Helmut Urban^{1

2}, Arschang Valipour^{1

2}

Affiliations

¹ Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Vienna, Austria.
² Department of Internal and Respiratory Medicine, Klinik Floridsdorf, Vienna, Austria.
³ Department of Emergency Medicine, Klinik Hietzing, Vienna, Austria.
⁴ Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria.
⁵ Department of Pediatrics, Klinik Donaustadt, Vienna, Austria.

Abstract

Background and Objectives: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for cardiovascular disease. This study aimed to investigate the relationship between pulmonary hyperinflation and baroreceptor reflex sensitivity (BRS), a surrogate for cardiovascular risk. Methods: 33 patients with COPD, free from clinical cardiovascular disease, and 12 healthy controls were studied. Participants underwent pulmonary function and non-invasive hemodynamic measurements. BRS was evaluated using the sequence method during resting conditions and mental arithmetic stress testing. Results: Patients with COPD had evidence of airflow obstruction [forced expiratory volume in 1 s predicted (FEV₁%) 26.5 (23.3-29.1) vs. 91.5 (82.8-100.8); P < 0.001; geometric means (GM) with 95% confidence interval (CI)] and lung hyperinflation [residual volume/total lung capacity (RV/TLC) 67.7 (64.3-71.3) vs. 41.0 (38.8-44.3); P < 0.001; GM with 95% CI] compared to controls. Spontaneous mean BRS (BRSmean) was significantly lower in COPD, both during rest [5.6 (4.2-6.9) vs. 12.0 (9.1-17.6); P = 0.003; GM with 95% CI] and stress testing [4.4 (3.7-5.3) vs. 9.6 (7.7-12.2); P < 0.001; GM with 95% CI]. Stroke volume (SV) was significantly lower in the patient group [-21.0 ml (-29.4 to -12.6); P < 0.001; difference of the means with 95% CI]. RV/TLC was found to be a predictor of BRS and SV (P < 0.05 for both), independent of resting heart rate. Conclusion: We herewith provide evidence of impaired BRS in patients with COPD. Hyperinflation may influence BRS through alteration of mechanosensitive vagal nerve activity.

Keywords: BRS; COPD; autonomic nervous system; baroreceptor reflex sensitivity; cardiopulmonary interaction; cardiovascular disease; chronic obstructive pulmonary disease; lung hyperinflation.