title: Chronotropic incompetence predicts mortality in severe obstructive pulmonary disease.
abstract: 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.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: José
authors.initials: J
authors.lastname: González-Costello
authors.forename: Hilary F
authors.initials: HF
authors.lastname: Armstrong
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.forename: Anna C
authors.initials: AC
authors.lastname: Bevelaqua
authors.forename: Laurie
authors.initials: L
authors.lastname: Letarte
authors.forename: Byron M
authors.initials: BM
authors.lastname: Thomashow
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Bartels
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology*; D015331:Cohort Studies; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: Chronic obstructive pulmonary disease; Chronotropic incompetence; Heart rate reserve