title: Intercostal muscle blood flow limitation during exercise in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  It has been hypothesized that, because of the high work of breathing sustained by patients with chronic obstructive pulmonary disease (COPD) during exercise, blood flow may increase in favor of the respiratory muscles, thereby compromising locomotor muscle blood flow.
  
  
  OBJECTIVE
  To test this hypothesis by investigating whether, at the same work of breathing, intercostal muscle blood flow during exercise is as high as during resting isocapnic hyperpnea when respiratory and locomotor muscles do not compete for the available blood flow.
  
  
  METHODS
  Intercostal and vastus lateralis muscle perfusion was measured simultaneously in 10 patients with COPD (FEV₁ = 50.5 ± 5.5% predicted) by near-infrared spectroscopy using indocyanine green dye.
  
  
  RESULTS
  Measurements were made at several exercise intensities up to peak work rate (WRpeak) and subsequently during resting hyperpnea at minute ventilation levels up to those at WRpeak. During resting hyperpnea, intercostal muscle blood flow increased with the power of breathing to 11.4 ± 1.6 ml/min per 100 g at the same ventilation recorded at WRpeak. Conversely, during graded exercise, intercostal muscle blood flow remained unchanged from rest up to 50% WRpeak (6.8 ± 1.3 ml/min per 100 g) and then fell to 4.5 ± 0.8 ml/min per 100 g at WRpeak (P = 0.003). Cardiac output plateaued above 50% WRpeak (8.4 ± 0.1 l/min), whereas vastus lateralis muscle blood flow increased progressively, reaching 39.8 ± 7.1 ml/min per 100 g at WRpeak.
  
  
  CONCLUSIONS
  During intense exercise in COPD, restriction of intercostal muscle perfusion but preservation of quadriceps muscle blood flow along with attainment of a plateau in cardiac output represents the inability of the circulatory system to satisfy the energy demands of locomotor and respiratory muscles.
authors.affiliation: Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, M. Simou, and G.P. Livanos Laboratories, National and Kapodistrian University of Athens, Athens, Greece. gianvog@phed.uoa.gr
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vogiatzis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Athanasopoulos
authors.forename: Helmut
authors.initials: H
authors.lastname: Habazettl
authors.forename: Andrea
authors.initials: A
authors.lastname: Aliverti
authors.forename: Zafiris
authors.initials: Z
authors.lastname: Louvaris
authors.forename: Evgenia
authors.initials: E
authors.lastname: Cherouveim
authors.forename: Harrieth
authors.initials: H
authors.lastname: Wagner
authors.forename: Charis
authors.initials: C
authors.lastname: Roussos
authors.forename: Peter David
authors.initials: PD
authors.lastname: Wagner
authors.forename: Spyros
authors.initials: S
authors.lastname: Zakynthinos
mesh_terms: D000368:Aged; D004396:Coloring Agents; D015444:Exercise / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007208:Indocyanine Green; D007366:Intercostal Muscles / Q000098:blood supply* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D052097:Quadriceps Muscle / Q000098:blood supply* / Q000503:physiopathology; D012039:Regional Blood Flow; D012129:Respiratory Function Tests; D019265:Spectroscopy, Near-Infrared; D014939:Work of Breathing / Q000502:physiology*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green