Vascular endothelial damage in COPD: current functional assessment methods and future perspectives

ABSTRACT

Introduction: Cardiovascular disease is a major cause of death in chronic obstructive pulmonary disease (COPD), but the relationship between these two entities is not fully understood; smoking, inflammation, arterial stiffness and endothelial dysfunction are significant determinants. Endothelial dysfunction is not only associated with cardiovascular disease, but also with COPD severity.

Areas covered: Several functional methods have been developed to evaluate endothelial function in healthy and diseased individuals; from the invasive angiography of epicardial coronary arteries and Venous-Occlusion-Plethysmography, to more modern, noninvasive approaches such as Flow-Mediated-Dilatation, Peripheral-Arterial-Tonometry and Near-Infrared-Spectroscopy, all these methods have boosted clinical research in this field. In this context, this narrative review, which included articles published in PubMed and Scopus up to 25-November-2020, summarizes available functional methods for endothelial damage assessment in COPD and discusses existing evidence on their associations with comorbidities and outcomes in this population.

Expert opinion: Accumulated evidence suggests that endothelial dysfunction occurs in early stages of CΟPD and worsens with pulmonary obstruction severity and during acute exacerbations. Novel methods evaluating endothelial function offer a detailed, real-time assessment of different parameters related to vascular function and should be increasingly used to shed more light on the role of endothelial damage on cardiovascular and COPD progression.

KEYWORDS:

• COPD
• microvascular function
• endothelial dysfunction
• flow-mediated dilatation
• NIRS

Article highlights

• Endothelial dysfunction, the basis of atherosclerosis, is present in a significant subset of COPD patients. It contributes to the development of cardiovascular disease in this population, but it is also related to COPD severity.

• Through the years, several functional methods have been applied to assess endothelial function in patients with COPD; flow-mediated dilatation (FMD) of the forearm is a non-invasive, simple technique that is the most commonly used in clinical research, as it presents strong correlations with coronary endothelial function.

• Several observational studies have shown that endothelial function impairment is associated with lung function and it is significantly declined during acute exacerbations. The results from clinical trials evaluating the effects of pharmacological and non-pharmacological trials (i.e. exercise programs) are limited and contradictory.

• Novel methods evaluating microvascular function (e.g. Near-infrared spectroscopy, video-capillaroscopy, etc.), can offer a detailed, real-time assessment of underlying phenomena and should be increasingly used to shed more light on the role of endothelial dysfunction on the associations between COPD and adverse cardiovascular outcomes.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.