Hospitalized Acute Exacerbation of COPD Impairs Flow and Nitroglycerin-Mediated Peripheral Vascular Dilation

Figures & data

Figure 1  Study design: 19 patients were enrolled in the study at time of AECOPD admission. All 19 had FMD but 1 patient was unable to receive sublingual nitroglycerin secondary to systolic blood pressure below 100 mmHg. Then, 11 patients did not return for repeat FMD or NMD because 7 were lost to follow-up, 2 had repeat AECOPD, 1 was transplanted and 1 died. Eight of the remaining patients had FMD. One patient was unable to have NMD at follow up due to systolic blood pressure <100 mm Hg. Definition of abbreviations: AECOPD (acute exacerbation of COPD), FMD (Flow-mediated dilation), NMD (Nitroglycerin-mediated dilation).

Table 1  Comparison of patients at admission and those that had follow up FMD

	AECOPD (n = 19)	COPD Follow-up (n = 8)	P value	Healthy non-smokers (n = 9)
Age, yrs	61 ± 7	61 ± 8	1.0	53 ± 6
Caucasian, #(%)	9 (47.4)	5 (62.5)	0.77	9 (100)
Men, #(%)	12 (63.1)	4 (50)	0.84	6 (66)
FEV1,% predicted (n = 16)	26 ± 16	33 ± 22	0.36	n/a
pH (n = 11)	7.37 ±.07	n/a	n/a	n/a
PaCO2 (mmHg) (n = 11)	54.5 ± 17.4	n/a	n/a	n/a
Smoking burden, pack yrs	52 ± 25	51 ± 22	0.92	0
BMI (Kg/m^2)	27 ± 7	29. ± 7	0.66	n/a
ATP risk (n = 12)	7.4 ± 3.3	9.1 ± 3.3	0.23	4.6 ± 1.4
Current smoking, #(%)	3 (15.8)	1 (12.5)	0.71	0
Diabetes, #(%)	2 (10.5)	1 (12.5)	0.59	0
Hypertension, #(%)	10 (52.6)	4 (50)	0.76	1 (11)
Cardiomyopathy, #(%)	1 (5.3)	0	0.65	0
Hypercholesterolemia, #(%)	10 (52.6)	5 (62.5)	0.96	1 (11)
Depression, #(%)	6 (31.6)	2 (25)	0.91	1 (11)
Coronary artery disease, #(%)	2 (10.5)	0	0.88	0
ACE inhibitor, #(%)	3 (15.8)	2 (25)	0.88	0
Beta-blocker, #(%)	2 (10.5)	0 (0)	0.88	0
Calcium channel blocker, #(%)	3 (15.8)	1 (12.5)	0.71	0
Statin, #(%)	7 (36.8)	2 (25)	0.88	1 (11)
BP (systolic) mmHg	133 ± 19	133 ± 20	1.0	127 ± 14
BP (diastolic) mmHg	76 ± 10	72 ± 10	0.35	72 ± 12
BP (mean) mmHg	95± 10	92 ± 9	0.47	89 ± 10
HR, bpm	92 ± 16	93 ± 19	0.89	75 ± 8
Oxygen requirement, LPM	2.8 ± 1.4	1.8 ± 1.2	0.09	0

Definition of abbreviations: BMI (body mass index), ATP (adult treatment panel), ACE (angiotensin converting enzyme), BP (blood pressure), HR (heart rate), bpm (beats per minute), LPM (liters per minute), n/a (not available).

There was no statistical difference between the AECOPD and COPD follow-up groups.

Figure 2  Individual FMD in the 8 patients that had measurements at admission (FMD 1) and follow-up (FMD 2). The horizontal bar represents the mean FMD at that time point. FMD improved from 2.6 ± 1.5% at admission to the hospital to 5.1 ± 2.4% on follow-up (p = 0.04).

Figure 3  Individual NMD in the 7 patients that had measurements at admission (NMD 1) and follow-up (NMD 2). The horizontal bar represents the mean NMD at that time point. NMD improved from 5.0 ± 2.6% to 13.3 ± 4.5% on follow-up (p = 0.02).