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

Figures & data

Table 1 Comparison of Baseline Characteristics of Patients in Various Study Groups

Parameters	Non-COPD (n=45)	COPD-GOLD1 (n=37)	COPD-GOLD2 (n=40)	COPD-GOLD3 (n=44)	COPD-GOLD4 (n=30)	P value
Age (years)	63.15±7.14	67.30±9.31	67.85±8.75	68.84±7.56	70.53±6.55	0.0532
Gender (male %)	28 (62.22)	27 (72.97)	29 (72.5)	32 (72.73)	22 (73.33)	0.7569
FEV1/expected FEV1(%)	99.22±5.94	84.30±6.01	58.21±6.76	40.01±5.44	27.36±4.26	< 0.0001
FVC/expected FVC (%)	97.43±9.46	88.95±10.2	76.53±14.47	55.71±10.97	48.04±9.91	< 0.0001
FEV1/FVC (%)	89.85±3.53	65.21±3.58	59.05±10.07	56.62±9.43	45.88±11.64	< 0.0001
AHR (beats/min)	71.02±10.42	72.86±10.20	73.45±10.04	74.57±10.24	78.30±12.82	0.0274
LVEF (%)	61.36±6.01	60.89±6.02	61.63±8.12	59.14±3.96	58.24±4.95	0.1918
PASP (mmHg)	25.97±10.40	25.92±5.23	27.24±6.02	26.85±3.68	30.47±7.53	0.2357
Hypertension (%)	4 (8.89)	4 (11.76)	4 (10.00)	5 (11.36)	4 (13.33)	0.9814
Diabetes mellitus (%)	2 (4.44)	3 (8.11)	2 (5.00)	3 (6.82)	3 (10.00)	0.9120
Coronary heart disease (%)	2 (4.44)	3 (8.11)	4 (10.00)	4 (9.09)	3 (10.00)	0.8788
History of anticholinergic therapy (%)	0 (0.00)	1 (2.70)	6 (15.00)	9 (20.45)	10 (33.33)	0.0001
History of steroid therapy (%)	0 (0.00)	6 (16.21)	30 (75.00)	40 (90.90)	27 (90.00)	< 0.0001

Notes: Data presented as mean±standard deviation or frequency (%). P-values pertain to the difference between patients in the control group versus all patients in the COPD group.

Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease; FVC, forced vital capacity; FEV1, forced expiratory volume in the first second; AHR, average heart rate; LVEF, left ventricular ejection fraction; PASP, pulmonary artery systolic pressure.

Table 2 Comparison of the Incidence of Arrhythmias in Various Study Groups

		Non-COPD (n=45)	COPD				P value
			GOLD1 (n=37)	GOLD2 (n=40)	GOLD3 (n=44)	GOLD4 (n=30)
Supra-ventricular arrhythmias	PAC [M (QR)]	138.3 (4.5–60.5)	291.9 (4.5–204.0)	626.8 (5.0–255.8)	881.2 (19.0–569.0)	1425 (20.8–1589)	0.0025
	PAC>70/d(n, %)	10 (22.2)	12 (32.4)	16 (40.0)	26 (59.1)	20 (66.7)	0.0018
	SVT (n, %)	11 (24.4)	18 (48.6)	20 (50.0)	24 (54.5)	22 (73.3)	<0.0001
Ventricular arrhythmias	PVC [M (QR)]	81.5 (0.0–4.5)	195.6 (0.5–119.5)	270.7 (0.25–124.0)	819.6 (0.0–240.8)	1048.0 (1.0–956.3)	0.0015
	PVAC (%)	6 (13.3)	5 (13.5)	9 (22.5)	11 (25.0)	13 (43.3)	0.1069

Notes: Data presented as mean±standard deviation, frequency (%), or median (interquartile range). P-values pertain to the difference between patients in the control group versus all patients in the COPD group.

Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease; PAC, premature atrial contraction; PVC, premature ventricular contraction; SVT, supraventricular tachycardia; PVAC, positive ventricular arrhythmia category; M (QR), median (interquartile range).

Table 3 Comparison of DRs in Various Study Groups

	Non-COPD (n=45)	COPD				P value
		GOLD1 (n=37)	GOLD2 (n=40)	GOLD3 (n=44)	GOLD4 (n=30)
DR2 (%)	7.69±1.67	7.58±1.42	7.41±1.47	7.30±1.75	5.69±1.97	0.0427
DR4 [M (QR),%]	0.66 (0.39–0.87)	0.49 (0.33–0.56)	0.44 (0.28–0.59)	0.27 (0.12–0.35)	0.22 (0.086–0.34)	<0.0001
DR8 [M (QR),%]	0.25 (0.0075–0.04)	0.017 (0.002–0.03)	0.013 (0.00–0.02)	0.056 (0.00–0.0058)	0.0043 (0.00–0.0057)	<0.0001
Risk Stratification Based on DRs
Low risk (%)	38 (84.5)	25 (67.6)	18 (45.0)	13 (29.5)	7 (23.3)	<0.0001
Intermediate risk+	7 (15.5)	12 (32.4)	22 (55.0)	31 (70.5)	23 (76.7)	<0.0001
High risk (%)

Notes: Data presented as mean±standard deviation, frequency (%), or median (interquartile range). P-values pertain to the difference between patients in the control group versus all patients in the COPD group.

Abbreviations: DR₂, DR₄, and DR₈, episodes of 2, 4, or 8 consecutive beat-to-beat heart rate decelerations, respectively; M (QR), median (interquartile range); COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease.

Table 4 Correlation Between Deceleration Capacity and the Incidence of Arrhythmias

Parameters	PAC		PVC		SVT		PVAC
	r	P	r	P	r	P	r	P
DR2	−0.3064	0.0001	−0.2102	0.0096	−0.2059	0.0112	−0.2944	0.0002
DR4	−0.5103	<0.0001	−0.3310	<0.0001	−0.3106	0.0001	−0.2966	0.0002
DR8	−0.1653	0.0425	−0.2389	0.0031	−0.3019	0.0002	−0.2362	0.0035

Abbreviations: PAC, premature atrial contraction; PVC, premature ventricular contraction; SVT, supraventricular tachycardia; PVAC, positive ventricular arrhythmia category.

Table 5 Comparison of Area Under the ROC Curve for Predicting Arrhythmias Based on DRs

		AUC (95% CI)	Cutoff (%)	Sensitivity (%)	Specificity (%)	P
DR2	PAC >70/d	0.6589 (0.5619–0.7560)	<6.25	43.42	88.89	0.0036
	SVT	0.6375 (0.5428–0.7323)	<6.15	40.00	88.89	0.0093
	PVAC	0.7352 (0.6218–0.8486)	<6.55	69.44	75.56	0.0003
DR4	PAC >70/d	0.8488 (0.7742–0.9234)	<0.505	94.74	64.44	<0.001
	SVT	0.8298 (0.7528–0.9067)	<0.565	93.33	60.00	<0.001
	PVAC	0.8725 (0.7986–0.9465)	<0.405	86.11	75.56	<0.001
DR8	PAC >70/d	0.8360 (0.7613–0.9107)	<0.0049	71.05	86.67	<0.001
	SVT	0.8380 (0.7672–0.9088)	<0.0049	70.00	86.67	<0.001
	PVAC	0.8998 (0.8179–0.9617)	<0.0059	86.11	82.22	<0.001

Abbreviations: ROC, receiver operating characteristic; AUC, area under the curve; PAC, premature atrial contraction; PVC, premature ventricular contraction; SVT, supraventricular tachycardia; PVAC, positive ventricular arrhythmia category; CI, confidence interval.

Figure 1 Relationship between DRs and arrhythmias in the COPD group. (A) The order of AUC of ROC curve is DR4>DR8>DR2 for PAC >70/d; (B) the order of AUC of ROC curve is DR8>DR4>DR2 for SVT; (C) the order of AUC of ROC curve is DR8>DR4>DR2 for PVAC.

Abbreviations: COPD, chronic obstructive pulmonary disease; AUC, area under the curve; ROC, receiver operating characteristic.