Identifying Right Ventricular Dysfunction in COPD Through Right Heart Catheterization, Imaging and Exercise

Inclusion Criteria:

• COPD (determined by ratio of forced expiratory volume in 1 second to forced vitalcapacity [FEV1/FVC] <0.7) • Pulmonary artery enlargement determined by pulmonaryartery-to-aorta ratio >1 or >30 mm on most recent CT

Exclusion Criteria:

• Exacerbation of COPD or use of systemic corticosteroids in the 3 months prior toenrollment

• Change in COPD therapy in the 3 weeks prior to enrollment

• Requirement of >6 LPM supplemental oxygen at rest

• Requirement of >10 LPM with exertion

• Active/uncontrolled cardiovascular disease (e.g. hypertension with blood pressure >150/100 despite antihypertensives; coronary artery disease with angina; leftventricular ejection fraction ≤40%; arrhythmia; pulmonic, mitral or aortic valvularabnormality greater than mildin severity; tricuspid regurgitation greater thanmoderate in severity; diabetes with HbA1c >8.5%)

• Volume overload (jugular vascular distension or greater than trace peripheral edema)

• Interstitial lung disease

• Untreated severe obstructive sleep apnea

• Active malignancy

• Medical conditions that limit exercise on an upright stationary bicycle (e.g.osteoarthritis, etc.)

• Pregnancy

• Body mass index <18 or >35

• Hematocrit <25% or >55%

• For optional Part 2 i.e. exercise training and Visit 2, residence >90 miles fromUniversity of Colorado Anschutz Medical Campus or unwillingness/inability to attendexercise training sessions for approximately 35 minutes 3x/week for 12 weeks

• For optional Part 2 i.e. exercise training and Visit 2, already engaged in routineexercise training (>30 minutes at >3 METs 3 times/week or more)