Background: Endothelial dysfunction (ED) is a common finding in patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). However, the impact of COPD overlap HF in its different clinical presentations [preserved (HFpEF) and reduced ejection fraction (HFrEF)] on ED is unknown. Aim: To investigate if the coexistence of COPD + HF may add impact on endothelial function compared to isolated COPD and verify different impact according HF type. Methods: Cross-sectional study involving 37 patients allocated into three groups: (1) COPD (n=10); (2) COPD+HFpEF (n=14); and (3) COPD+HFrEF (n=13). Spirometry and transthoracic echocardiography were carried out in all patients to confirm the diagnosis of COPD and HF respectively. Endothelial function was assessed using the brachial artery flow-mediated dilation (FMD) method. Results: A reduced FMD (%) was found in COPD+HFrEF group compared to COPD group (3.53 ± 1.49 vs. 5.85 ± 2.97; p<0.05) with no difference between the COPD+HFpEF and COPD+HFrEF. FMD (%) was positively associated with LVEF (r = 0.42; p = 0.01) and negatively associated with age (r = -0.33; p = 0.04). Additionally, LVEF in a univariate regression model was able to explain 43% of the FMD (%) variance. Conclusion: A more impaired endothelial dysfunction was identified when HFrEF coexists with COPD. The greater LVEF, the greater endothelial function. These results emphasize the deleterious effects of cardiovascular comorbidity in COPD.

Financial support: FAPESP 2015/26501-1 and CNPq 102489/2022-0