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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Exercise intolerance significantly impacts quality of life&#44; morbidity&#44; and mortality in chronic obstructive pulmonary disease &#40;COPD&#41;&#46; While ventilation and perfusion disorders are crucial in explaining exercise intolerance&#44; peripheral muscle dysfunction also plays a key role&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> Many studies on COPD-related peripheral muscle dysfunction focus on the quadriceps muscle&#44; revealing that low muscle strength may be linked to exercise intolerance and poor prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In studies on the quadriceps muscle in COPD patients&#44; bicycle ergometers have been primarily used to evaluate muscle fatigue&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4&#44;5</span></a> In daily practice&#44; the 6-minute walk test &#40;6MWT&#41; is used more frequently to evaluate the relationship between pulmonary and pulmonovascular diseases and exercise capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> Peripheral muscle groups that play a role in flexion&#44; inversion&#44; and plantar flexion of the foot are more involved in the continuity of the walking action&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The gastrocnemius muscle &#40;GM&#41; is a peripheral extremity muscle that is important in walking&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#44;9</span></a> In our study&#44; we examined the measurement of GM by shear wave elastography &#40;SWE&#41; in COPD patients and its relationship with oxygenation levels&#44; respiratory function test &#40;PFT&#41; parameters&#44; and 6MWT results&#46; This research aims to enhance management and rehabilitation strategies for COPD by improving our understanding of muscle functions and exercise tolerance in these patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study involved 20 patients over 40 with group E COPD and 20 healthy controls&#44; all with right dominant feet&#46; Conducted at XXX University Chest Diseases Clinic &#40;December 2023&#8211;March 2024&#41;&#46; COPD diagnosis was confirmed via postbronchodilator PFT &#40;Cosmed Q-Box Body Plethysmography&#41;&#46; Patients had FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>70&#37;&#44; stable for four weeks&#44; and fingertip saturation<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>85&#37; on room air&#46; Records from the hospital or e-Nabiz were reviewed for systemic steroid therapy equivalent to 8<span class="elsevierStyleHsp" style=""></span>mg&#47;day methylprednisolone&#46; Group E classification required two or more acute exacerbations or one hospitalization&#46; Patients unable to perform PFT and 6MWT or with lower extremity thrombophlebitis were excluded&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All SWE examinations used an ultrasonography device &#40;Epiq Elite&#44; Philips Medical Systems&#41; with a 22-2<span class="elsevierStyleHsp" style=""></span>MHz transducer&#46; The transducer was gently applied to the hydrogel-covered skin to avoid compression bias&#46; Measurements were taken at the posteromedial section of the cruris&#44; where the GM is thickest&#46; Three 2<span class="elsevierStyleHsp" style=""></span>mm region of interests were placed within the SWE window&#44; and their shear modulus data were recorded in kilopascals &#40;kPa&#41;&#46; After SWE&#44; a near-infrared spectroscopy probe &#40;MOXY&#44; Minnesota&#44; USA&#41; was fixed to the GM abdomen&#46; Measurements were taken with the leg in neutral and dorsiflexed positions for one minute each&#44; starting with the right leg&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">IBM SPSS Statistics for Windows version 22&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#41; was used for statistical analyses&#46; G&#42;Power analysis determined the sample size &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <span class="elsevierStyleItalic">d</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;50&#41;&#44; requiring a minimum of 20 patients&#46; Pearson&#39;s Chi-square test was used for parametric data comparisons between groups&#44; and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for non-normally distributed data&#46; The Kruskal&#8211;Wallis test compared demographic data and laboratory parameters&#44; while an independent sample <span class="elsevierStyleItalic">t</span>-test analyzed parameters with significant Kruskal&#8211;Wallis test results&#46; Multivariate analysis used the MANOVA test&#44; and Spearman correlation analysis compared laboratory parameters and radiological scores&#46; A <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The average age of COPD patients was 63&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;8 years&#44; and the control group was 61&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;3 years&#46; In the COPD group&#44; 60&#37; were male&#44; while in the control group&#44; 55&#37; were male&#46; Statistical analysis showed no significant difference in age &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#41; and gender &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#41; between the groups&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">No statistical differences were observed in height &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;45&#41;&#44; weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#41;&#44; and BMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;28&#41; between the groups&#46; However&#44; FVC&#37;&#44; FEV<span class="elsevierStyleInf">1</span>&#37;&#44; and FEV<span class="elsevierStyleInf">1</span>&#47;FVC values were significantly higher in the control group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 for all&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the COPD group&#44; no significant gender differences were observed in right and left GM SWE &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#44; 0&#46;78&#41;&#44; while the control group showed higher SWE levels in men &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the control group&#44; the correlation of bilateral GM minimum and maximum SmO<span class="elsevierStyleInf">2</span>&#44; bilateral SWE&#44; and 6MWT was positive&#44; with a correlation between right GM SWE and 6MWT &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;89&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and left GM SWE and 6MWT &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;76&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; A positive correlation was also observed between right maximum SmO<span class="elsevierStyleInf">2</span> and 6MWT &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the correlation of bilateral GM minimum and maximum SmO<span class="elsevierStyleInf">2</span>&#44; bilateral SWE&#44; PFT parameters&#44; 6MWT&#44; Borg dyspnea score&#44; and the number of days of steroid treatment in COPD patients&#46; It was observed that right and left maximum and minimum SmO<span class="elsevierStyleInf">2</span> were negatively correlated with the number of days of steroid treatment &#40;Right Gast&#46;&#58; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;63&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;54&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; Left Gast&#46;&#58; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;58&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;58&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows a multivariate analysis of right and left GM SWE levels in the COPD and control groups with age&#44; gender&#44; and number of days of steroid treatment&#46; The right GM SWE level showed a statistically significant difference with both the number of days of steroid use &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and gender &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">6MWT is more practical than the bicycle ergometer in assessing exercise capacity in COPD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> The quadriceps muscle has been frequently used in studies on muscle strength and exercise capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> However&#44; the bicycle ergometer did not show as much of a relationship with fatigue as the walking test&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> It has also been observed that the muscles that contribute to dorsal and plantar flexion from the peripheral extremities are more prone to fatigue in walking&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> In addition&#44; Type 2 muscle fibers&#44; which are involved in forced breathing&#44; are more dense in the GM&#44; making them more susceptible to fatigue&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> These factors were effective in choosing GM in our study&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the correlation analysis performed in the control group&#44; bilateral GM SWE levels were highly correlated with the 6MWT&#46; However&#44; this correlation decreased and remained statistically significant in the COPD group&#46; Additionally&#44; the correlation between SmO<span class="elsevierStyleInf">2</span> level and 6MWT in the control group was not observed in the COPD group&#46; PFT parameters&#44; strength level in respiratory muscles and other muscles affecting walking&#44; and dyspnea level may also have affected the decrease in 6MWT level in COPD patients&#46; Additionally&#44; steroid treatment applied to COPD patients may have affected the SmO<span class="elsevierStyleInf">2</span> level and GM SWE level&#44; causing a decrease in the correlation compared to the control group&#46; In multivariate analysis&#44; the effect of the number of days of steroid treatment on SWE level confirms this&#46; The higher level of SWE in men in the control group may have affected the relationship between gender and SWE level&#46; The dominance of this foot may have played a role in the higher right foot correlation in the groups&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The evaluation of GM oxygenation and SWE levels was focused on group E COPD patients&#46; Studies including group A and B COPD patients can support these results&#46; Additionally&#44; gender effects on SWE must be considered for this group&#44; which actively uses peripheral extremity muscles&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As a result&#44; steroid treatment applied to group E COPD patients affects the GM SWE level less than the SmO2 level&#46; It evaluates individuals&#8217; 6MWT levels better than PFT and SmO2 levels&#46; Therefore&#44; GM SWE may be a follow-up parameter that can be used to evaluate patients&#8217; exercise capacity&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical approval</span><p id="par0080" class="elsevierStylePara elsevierViewall">All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and&#47;or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards&#46; The research protocol was approved by the XXX University Ethics Committee &#40;B&#46;30&#46;2&#46;ATA&#46;0&#46;01&#46;00&#47;427&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">The study was supported by the <span class="elsevierStyleGrantSponsor" id="gs1">Research Fund</span> of Ataturk University &#40;Project Number&#58; 11581&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Informed consent</span><p id="par0090" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all individual participants included in the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest to the publication of this article&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Right max&#46; Gast&#46; SmO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="10" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="10" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Left min&#46; Gast&#46; SmO</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " colspan="10" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Right SWE &#40;kPa&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#46;44<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="10" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Left SWE &#40;kPa&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Right Gast&#46; SWE &#40;kPa&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Left Gast&#46; SWE &#40;kPa&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Right Gast&#46; SWE &#40;kPa&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1924&#46;77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left Gast&#46; SWE &#40;kPa&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Age &#40;years&#41;</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Left Gast&#46; SWE &#40;kPa&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;395&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right Gast&#46; SWE &#40;kPa&#41;&nbsp;\t\t\t\t\t\t\n
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Journal Information
Vol. 60. Issue 10.
Pages 643-645 (October 2024)
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Vol. 60. Issue 10.
Pages 643-645 (October 2024)
Scientific Letter
New Indicators of Exercise Capacity and Respiratory Function in COPD Patients: The Role of Gastrocnemius Muscle Oxygenation and Elastography Levels
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Buğra Kergeta,
Corresponding author
bjkerget1903@gmail.com

Corresponding author.
, İsmail Çınara, Büşra Nur Akdağa, Mustafa Yeşilyurtb, Muhammed Furkan Barutçugilb, Fatih Alperb
a Department of Pulmonary Diseases, Ataturk University School of Medicine, Yakutiye, Erzurum, Turkey
b Department of Radiology, Ataturk University School of Medicine, Yakutiye, Erzurum, Turkey
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Tables (2)
Table 1. Correlation analysis between muscle oxygenation, SWE, PFT parameters and 6MWT distances in COPD patients.
Table 2. Multivariate analysis of right and left GM SWE levels in the COPD and control groups.
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