Blog
About

0
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Risk Prediction for Arrhythmias by Heart Rate Deceleration Runs in Patients with Chronic Obstructive Pulmonary Disease

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          Chronic obstructive pulmonary disease (COPD) is associated with increased incidence of arrhythmias, which has been attributed to autonomic dysregulation. Detection of autonomic function may facilitate stratification of COPD patients with respect to their risk of development of arrhythmias.

          Patients and Methods

          A total of 151 COPD patients and 45 non-COPD patients were included in this study. Heart rate deceleration runs (DRs) were detected by dynamic electrocardiogram (ECG); DRs successively occurring in 2, 4, or 8 cardiac cycles were denoted as DR 2, DR 4, and DR 8, respectively. Indicators of arrhythmias including isolated premature atrial contractions (PAC), supraventricular tachycardia (SVT), isolated premature ventricular contractions (PVC), and ventricular tachycardia (VT) were recorded. Occurrence of SVT or PAC ≥70/day was considered positive for supraventricular arrhythmias, while positive ventricular arrhythmias category (PVAC) was defined as occurrence of VT or PVC ≥10/hour.

          Results

          Compared with non-COPD individuals, COPD patients were associated with increased number of PAC, PVC, higher incidence of PAC >70/d, SVT, PVAC, and decreased DRs (DR2, DR4, DR8) (P<0.05). In COPD patients, DRs showed a negative correlation with the incidence of PAC, PVC, SVT, and PVAC (P<0.05). In receiver operating characteristic curve analysis, all the DRs were found to be significant predictors of PAC >70/d, SVT, and PVAC. The predictive power of DRs was significantly different from one another with the order ranged as DR4>DR8>DR2 for PAC >70/d, DR8>DR4>DR2 for SVT, and DR8>DR4>DR2 for PVAC.

          Conclusion

          Our study provides evidence of significant autonomic dysregulation in COPD patients. DRs may serve as a marker of the risk of arrhythmias in COPD patients.

          Related collections

          Most cited references 19

          • Record: found
          • Abstract: found
          • Article: not found

          Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study.

          Decreased vagal activity after myocardial infarction results in reduced heart-rate variability and increased risk of death. To distinguish between vagal and sympathetic factors that affect heart-rate variability, we used a signal-processing algorithm to separately characterise deceleration and acceleration of heart rate. We postulated that diminished deceleration-related modulation of heart rate is an important prognostic marker. Our prospective hypotheses were that deceleration capacity is a better predictor of risk than left-ventricular ejection fraction (LVEF) and standard deviation of normal-to-normal intervals (SDNN). We quantified heart rate deceleration capacity by assessing 24-h Holter recordings from a post-infarction cohort in Munich (n=1455). We blindly validated the prognostic power of deceleration capacity in post-infarction populations in London, UK (n=656), and Oulu, Finland (n=600). We tested our hypotheses by assessment of the area under the receiver-operator characteristics curve (AUC). During a median follow-up of 24 months, 70 people died in the Munich cohort and 66 in the London cohort. The Oulu cohort was followed-up for 38 months and 77 people died. In the London cohort, mean AUC of deceleration capacity was 0.80 (SD 0.03) compared with 0.67 (0.04) for LVEF and 0.69 (0.04) for SDNN. In the Oulu cohort, mean AUC of deceleration capacity was 0.74 (0.03) compared with 0.60 (0.04) for LVEF and 0.64 (0.03) for SDNN (p<0.0001 for all comparisons). Stratification by dichotomised deceleration capacity was especially powerful in patients with preserved LVEF (p<0.0001 in all cohorts). Impaired heart rate deceleration capacity is a powerful predictor of mortality after myocardial infarction and is more accurate than LVEF and the conventional measures of heart-rate variability.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality.

            Chronic obstructive pulmonary disease and other disorders, associated with reduced lung function, are strong risk factors for cardiovascular events, independent of smoking. Overall, when the lowest quintile of lung function, as measured by FEV1 is compared with the highest quintile, the risk of cardiovascular mortality increases by approximately 75% in both men and women. Having symptoms of chronic bronchitis alone increases the risk of coronary deaths by 50%. Reduced ratio of FEV1 to FVC by itself is a modest independent risk factor for coronary events, increasing the risk by 30%. However, if patients have ventricular arrhythmias, the risk of coronary events is increased twofold, suggesting that the cardiotoxic effects of obstructive airways disease are amplified in those who have underlying cardiac rhythm disturbances. In general, for every 10% decrease in FEV1, all-cause mortality increases by 14%, cardiovascular mortality increases by 28%, and nonfatal coronary event increases by almost 20%. These data indicate that chronic obstructive pulmonary disease is a powerful, independent risk factor for cardiovascular morbidity and mortality.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.

              This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
                Bookmark

                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                17 March 2020
                2020
                : 15
                : 585-593
                Affiliations
                [1 ]Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine and Health Science , Shanghai 201306, People’s Republic of China
                [2 ]Department of Cardiology, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine and Health Science , Shanghai 201306, People’s Republic of China
                Author notes
                Correspondence: Xing-De Wang Department of Cardiology, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine and Health Science , No. 222 Huanhu West Road, Lingang New City, Pudong New Area, Shanghai201306, People’s Republic of ChinaTel +862138297277 Email sd_wangxd@sumhs.edu.cn
                Shao-Jun Yin Department of Respiratory Medicine, Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine and Health Science , No. 222 Huanhu West Road, Lingang New City, Pudong New Area, Shanghai201306, People’s Republic of ChinaTel +862138297762 Email yinshaojun2010@163.com
                Article
                234470
                10.2147/COPD.S234470
                7085327
                © 2020 Kong et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 5, References: 24, Pages: 9
                Categories
                Original Research

                Comments

                Comment on this article