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 vital capacity [FEV1/FVC] <0.7) • Pulmonary artery enlargement determined by pulmonary artery-to-aorta ratio >1 or >30 mm obtained within 3 years of enrollment and not during an acute exacerbation of COPD Exclusion Criteria: Exacerbation of COPD or use of systemic corticosteroids 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 >6 LPM 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 ≤45%; arrhythmia; pulmonic, mitral or aortic valvular abnormality greater than trace in severity; tricuspid regurgitation greater than mild in severity; diabetes with HbA1c >7.5%) Volume overload (jugular vascular distension or greater than trace peripheral edema) Interstitial lung disease Untreated obstructive sleep apnea Active malignancy Medical conditions that limit exercise on an upright stationary bicycle (e.g. osteoarthritis, etc.) Already engaged in routine exercise training (>30 minutes at >3 METs 3 times/week or more) Pregnancy Body mass index <18.5 or >35 Hematocrit <32% or >55% Contraindication to CMR (e.g. metallic or electrical implants, devices, or foreign bodies; severe renal insufficiency with estimated glomerular filtration rate <30 mL/min/1.73 m2) For optional Part 2 i.e. exercise training and Visit 2, residence >90 miles from University of Colorado Anschutz Medical Campus or unwillingness/inability to attend exercise training sessions for approximately 35 minutes 3x/week for 12 weeks For optional Part 2 i.e. exercise training and Visit 2, unwillingness to comply with exercise gym COVID precautions, including being up-to-date on COVID vaccination (primary series plus one booster, if eligible)