TY - JOUR
T1 - Chronotropic incompetence predicts mortality in severe obstructive pulmonary disease
AU - González-Costello, José
AU - Armstrong, Hilary F.
AU - Jorde, Ulrich P.
AU - Bevelaqua, Anna C.
AU - Letarte, Laurie
AU - Thomashow, Byron M.
AU - Bartels, Matthew N.
N1 - Funding Information:
This work was supported by the VIDDA Foundation , New York, NY; Grant number UL1 RR024156 from the National Center for Research Resources and NIH grant R01 HL 45095 .
PY - 2013/8/15
Y1 - 2013/8/15
N2 - We evaluated the prevalence of chronotropic incompetence (CI), a marker of autonomic dysfunction, and its prognostic value in patients with chronic obstructive pulmonary disease (COPD). We performed a retrospective analysis of 449 patients with severe COPD who underwent a cardiopulmonary exercise test, after excluding patients with lung volume reduction surgery, left ventricular dysfunction and those not in sinus rhythm. CI was defined as percent predicted heart rate reserve (%HRR). Events were defined as death or lung transplant during a median follow-up of 68 months. Median age was 61 years; median percent predicted forced expiratory volume in one second (%FEV1) of 25% and median %HRR of 33%. The hazard ratio for an event in the lowest quartile of %HRR, taking the highest quartile as reference, was of 3.2 (95% confidence interval: 2.1-4.8; p<0.001). In a multivariate regression model, %HRR was an independent predictor of events. In conclusion, CI was an independent and powerful outcome predictor in patients with severe COPD.
AB - We evaluated the prevalence of chronotropic incompetence (CI), a marker of autonomic dysfunction, and its prognostic value in patients with chronic obstructive pulmonary disease (COPD). We performed a retrospective analysis of 449 patients with severe COPD who underwent a cardiopulmonary exercise test, after excluding patients with lung volume reduction surgery, left ventricular dysfunction and those not in sinus rhythm. CI was defined as percent predicted heart rate reserve (%HRR). Events were defined as death or lung transplant during a median follow-up of 68 months. Median age was 61 years; median percent predicted forced expiratory volume in one second (%FEV1) of 25% and median %HRR of 33%. The hazard ratio for an event in the lowest quartile of %HRR, taking the highest quartile as reference, was of 3.2 (95% confidence interval: 2.1-4.8; p<0.001). In a multivariate regression model, %HRR was an independent predictor of events. In conclusion, CI was an independent and powerful outcome predictor in patients with severe COPD.
KW - Chronic obstructive pulmonary disease
KW - Chronotropic incompetence
KW - Heart rate reserve
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U2 - 10.1016/j.resp.2013.05.002
DO - 10.1016/j.resp.2013.05.002
M3 - Article
C2 - 23669496
AN - SCOPUS:84880115319
SN - 1569-9048
VL - 188
SP - 113
EP - 118
JO - Respiratory Physiology and Neurobiology
JF - Respiratory Physiology and Neurobiology
IS - 2
ER -