TY - JOUR
T1 - Identifying a Heart Rate Recovery Criterion After a 6-Minute Walk Test in COPD
AU - Zhao, Dongxing
AU - Abbasi, Asghar
AU - Casaburi, Richard
AU - Adami, Alessandra
AU - Tiller, Nicholas B.
AU - Yuan, Wei
AU - Yee, Christopher
AU - Jendzjowsky, Nicholas G.
AU - Macdonald, David M.
AU - Kunisaki, Ken M.
AU - Stringer, William W.
AU - Porszasz, Janos
AU - Make, Barry J.
AU - Bowler, Russell P.
AU - Rossiter, Harry B.
N1 - Publisher Copyright:
© 2021 Zhao et al.
PY - 2021
Y1 - 2021
N2 - Background: Slow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?. Study Design and Methods: A total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations. Results: HRR after 6MWT (bt/min) was categorized in quintiles: ≤5 (23.0% of participants), 6– 10 (20.7%), 11–15 (18.9%), 16–22 (18.5%) and ≥23 (18.9%). Compared to HRR≤5, HRR≥11 was associated with (p<0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV1%pred; lower airway wall area and wall thickness. HRR was positively associated with FEV1%pred and negatively associated with airway wall thickness. An optimal HRR ≤10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58–0.66) for identifying FEV1<30%pred. HRR≥11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤10 bt/min was associated with (p<0.001): ≥2 exacerbations in the previous year (OR=1.76[1.33–2.34]); CAT≥10 (OR=1.42[1.18–1.71]); mMRC≥2 (OR=1.42[1.19–1.69]); GOLD 4 (OR=1.98[1.44– 2.73]) and GOLD D (OR=1.51[1.18–1.95]). HRR≤10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07–3.12], P=0.027). Conclusion: HRR≤10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, suggesting that an abnormal HRR≤10 bt/min after a 6MWT may be used in a comprehensive assessment in COPD for risk of severity, symptoms and future exacerbations.
AB - Background: Slow heart rate recovery (HRR) after exercise is associated with autonomic dysfunction and increased mortality. What HRR criterion at 1-minute after a 6-minute walk test (6MWT) best defines pulmonary impairment?. Study Design and Methods: A total of 5008 phase 2 COPDGene (NCT00608764) participants with smoking history were included. A total of 2127 had COPD and, of these, 385 were followed-up 5-years later. Lung surgery, transplant, bronchiectasis, atrial fibrillation, heart failure and pacemakers were exclusionary. HR was measured from pulse oximetry at end-walk and after 1-min seated recovery. A receiver operator characteristic (ROC) identified optimal HRR cut-off. Generalized linear regression determined HRR association with spirometry, chest CT, symptoms and exacerbations. Results: HRR after 6MWT (bt/min) was categorized in quintiles: ≤5 (23.0% of participants), 6– 10 (20.7%), 11–15 (18.9%), 16–22 (18.5%) and ≥23 (18.9%). Compared to HRR≤5, HRR≥11 was associated with (p<0.001): lower pre-walk HR and 1-min post HR; greater end-walk HR; greater 6MWD; greater FEV1%pred; lower airway wall area and wall thickness. HRR was positively associated with FEV1%pred and negatively associated with airway wall thickness. An optimal HRR ≤10 bt/min yielded an area under the ROC curve of 0.62 (95% CI 0.58–0.66) for identifying FEV1<30%pred. HRR≥11 bt/min was the lowest HRR associated with consistently less impairment in 6MWT, spirometry and CT variables. In COPD, HRR≤10 bt/min was associated with (p<0.001): ≥2 exacerbations in the previous year (OR=1.76[1.33–2.34]); CAT≥10 (OR=1.42[1.18–1.71]); mMRC≥2 (OR=1.42[1.19–1.69]); GOLD 4 (OR=1.98[1.44– 2.73]) and GOLD D (OR=1.51[1.18–1.95]). HRR≤10 bt/min was predicted COPD exacerbations at 5-year follow-up (RR=1.83[1.07–3.12], P=0.027). Conclusion: HRR≤10 bt/min after 6MWT in COPD is associated with more severe expiratory flow limitation, airway wall thickening, worse dyspnoea and quality of life, and future exacerbations, suggesting that an abnormal HRR≤10 bt/min after a 6MWT may be used in a comprehensive assessment in COPD for risk of severity, symptoms and future exacerbations.
KW - COPD exacerbation
KW - autonomic dysfunction
KW - chest computed tomography
KW - exercise
KW - spirometry
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U2 - 10.2147/COPD.S311572
DO - 10.2147/COPD.S311572
M3 - Article
C2 - 34511898
AN - SCOPUS:85116019661
SN - 1176-9106
VL - 16
SP - 2545
EP - 2560
JO - International Journal of COPD
JF - International Journal of COPD
ER -
