Chronotropic incompetence can limit exercise tolerance in COPD patients with lung hyperinflation

Abstract

Purpose

Metabolic-chronotropic relationship is the only concept that assesses the entire chronotropic function during exercise, as it takes into account individual fitness. To better understand interrelationships between chronotropic incompetence (CI), dynamic hyperinflation (DH) and exercise limitation among Global initiative for chronic Obstructive Lung Disease (GOLD) stages of chronic obstructive pulmonary disease (COPD) disease severity, we evaluated cardiopulmonary responses to symptom-limited cycle exercise in stable patients.

Patients and methods

We prospectively studied 47 COPD patients classified by GOLD stage severity. Pulmonary function tests and cardiopulmonary responses to symptom-limited incremental exercise were studied. CI was defined by regression line between percent heart rate (HR) reserve and percent oxygen uptake (V’O₂) reserve, ie, chronotropic-metabolic index (CMI). DH was defined from the knot resulting from the nonlinear regressions of inspiratory capacity changes from rest to peak (dynamic inspiratory capacity (IC_dyn)) with percentage of maximal HR and CMI.

Results

Aerobic capacity (median interquartile ranges) peak V’O₂, 24.3 (23.6; 25.2), 18.5 (15.5; 21.8), 17.5 (15.4; 19.1) mL·kg⁻¹·min⁻¹ and CMI worsened according to GOLD severity. The optimal knot of IC_dyn was equal to −0.34 L. The multivariate logistic regression showed a strong relationship between CI (outcome) and DH (odds ratio [confidence interval 95]) 25 (3.5; 191.6).

Conclusion

COPD patients with DH have a poor cardiovascular response to exercise, which may be attributed to CI.

Keywords:

• COPD
• hyperinflation
• chronotropic incompetence
• exercise

Acknowledgments

The authors thank all of the staff of the Pulmonary Functional Tests Department for their help in this work.

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.