Phenotyping Resting and Exertional Right Ventricular Dysfunction Among Patients With Chronic Obstructive Pulmonary Disease

• Exercise (Behavioral): After a brief warmup, participants will be asked to perform approximately 5 minutes of exercise at moderate intensity and then approximately 2 minutes of exercise at high intensity.

Primary outcomes

• Right ventricular contractility measured by transthoracic echocardiography [Up to 1 hour]: Global longitudinal strain, measured in absolute percent

Secondary outcomes

• Right ventricular contractility measured by conductance catheter [Up to 1 hour]: Maximum rate of pressure change, dP/dtmax in mmHg/sec
• Right ventricular systolic function measured by transthoracic echocardiography [Up to 1 hour]: Fractional area change on transthoracic echocardiography, measured in percent
• Right ventricular systolic function measured by transthoracic echocardiography [Up to 1 hour]: Tricuspid annular plane systolic excursion on transthoracic echocardiography, measured in centimeters
• Health-related quality of life by Short Form 36 (SF-36) questionnaire [Up to 1 hour]: Units, range 0-100 with greater scores indicating a more favorable health state
• Maximum oxygen consumption (VO2max) [Up to 1 hour]: In L/min
• Plasma acylcarnitines measured via ultra-high-performance liquid chromatography coupled to mass spectrometry [Up to 1 hour]: Peak intensity, measured as arbitrary units
• Physical activity measured by activity monitor [7 days]: Time spent in moderate or vigorous activity in absolute percent

Sex: All, ages: 40 Years to any

Inclusion Criteria:

* COPD (determined by ratio of forced expiratory volume in 1 second to forced vital capacity \[FEV1/FVC\] <0.7)
* Age >= 40 years

Exclusion Criteria:

* Exacerbation of COPD in the 3 months prior to enrollment
* Change in COPD therapy in the 3 weeks prior to enrollment
* Requirement of >6 LPM supplemental oxygen at rest
* Requirement of >10 LPM supplemental oxygen with exertion
* Active/uncontrolled cardiovascular disease (e.g. hypertension with blood pressure >150/100 despite antihypertensives; coronary artery disease with angina; left ventricular ejection fraction ≤40%; arrhythmia; pulmonic, mitral or aortic valvular abnormality greater than mild in severity; tricuspid regurgitation greater than moderate in severity)
* Volume overload (jugular vascular distension or greater than trace peripheral edema)
* World Health Organization Functional Class IV
* Known pulmonary hypertension with mean pulmonary artery pressure >45 mmHg
* Untreated severe obstructive sleep apnea or obesity hypoventilation syndrome
* Active malignancy (other than skin)
* Medical conditions that limit exercise on an upright stationary bicycle (e.g. severe osteoarthritis, imbalance/gait instability, etc.)
* Pregnancy
* Body mass index <18 or >40
* Hematocrit <25% or >55%
* For invasive CPET, chronic anticoagulation that is unable to be held for the study visit
* For invasive CPET, forced expiratory volume in 1 second of <20%

• Lindsay Forbes, MD, Principal investigator, University of Colorado, Denver