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Angiotensin-Converting Enzyme Gene Polymorphisms and Tissue Oxygenation During Exercise: Materials and Methods

All patients satisfied the American Thoracic Society criteria for COPD. Patients with evidence of coronary artery disease, valvular heart disease, systemic hypertension, or primary myocardial disease were excluded from the study. None of the patients had radiologic or clinical evidence of pulmonary congestion or right-heart failure. Concomitant left ventricular dysfunction was excluded in all patients by echocardiography performed prior to the study. All patients with COPD were in clinically stable condition, and none had a history of respiratory infection for at least 4 weeks preceding the study. All patients gave their written informed consent for participation in this study, which was approved by the Ethics Committee of Osaka City University, Japan. canadian neighbor pharmacy

On the first day of the study, the subjects underwent a progressive incremental exercise test while sitting on an ergome-ter (EM840; Siemens; Munich, Germany), starting at 0 W for 3 min and adding 10 W every minute until symptom-limited maximum was reached. Expired gas analysis was performed during the exercise test with a respiratory monitor (Respiromoni-tor RM-300; Minato Medical Science; Osaka, Japan) to continuously measure oxygen consumption (Vo2). Heart rate was continuously monitored with standard ECG equipment. The purpose of this incremental exercise test was to determine the maximal exercise capacity. On the day following the test, all subjects underwent right-heart catheterization. All cardiopulmonary medications were withheld for at least 12 h before the study. A balloon-tipped pulmonary arterial catheter was inserted percutaneously into the internal jugular vein and advanced into the pulmonary artery for measurement of pulmonary arterial pressure (PAP) and pulmonary wedge pressure and sampling of mixed venous blood.