Prognostic value of the post-exercise heart rate recovery and BHDE-index in chronic obstructive pulmonary disease

BMC Pulmonary Medicine

Research

Chia-Ling Wu¹  Shih-Yu Chen²  Chong-Jen Yu³  Jung-Yien Chien⁴  Chun-Kai Huang⁵  Hui-Chuan Peng⁶ 

[1] Department of Integrated Diagnostic & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan;Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan;Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan;Department of Nursing, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;

关键词: Pulmonary rehabilitation;    Chronic obstructive pulmonary disease;    Pulmonary function;    Heart rate recovery;   

DOI  :  10.1186/s12890-023-02557-7

 received in 2023-05-07, accepted in 2023-07-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe BODE index, consisting of body mass index (B), airflow obstruction (O), dyspnea score (D), and exercise capacity (E), can predict outcomes in COPD. However, when spirometry was restricted to prevent cross-infection such as COVID-19 pandemic, a modified index would be needed. Because cardiovascular dysfunction is associated with poor clinical outcomes in COPD, we conducted a novel BHDE-index by replacing spirometry with post-exercise heart rate recovery (HRR, H) and evaluated its predictive performance in this observational study.MethodsFrom January 2019 to December 2019, enrolled patients were analyzed as a derivation cohort for the setup of the model. This model was verified in another group of patients generated between January 2020 and December 2020, as the validation cohort. The post exercise HRR was defined as the difference of heart rate immediately after and 1 min after test cessation.ResultsA total of 447 patients with COPD were enrolled. Patients with abnormal HRR were older, with more severe airway obstruction, severe airway symptoms, faster resting heart rate, shorter 6-min walk distance and higher frequency of severe acute exacerbation in previous one year. The prediction performance of the BHDE-index for one-year severe COPD exacerbation was similar to that of the BODE-index in both the derivation and validation groups [area under the receiver operating characteristic curve (AUROC) 0.76 vs. 0.75, p = 0.369; AUROC 0.74 vs. 0.79, p = 0.05]. The prediction performance for 1 year mortality was also similar between BHDE-index and BODE-index in both cohorts [AUROC 0.80 vs. 0.77, p = 0.564; 0.76 vs. 0.70, p = 0.234]. Univariate and multivariate analyses also showed that the BHDE-index was an independent and important predictor of annual severe COPD exacerbation in the derivation and validation cohorts.ConclusionsThe BHDE-index is a good and easy-to-perform prediction model for the risk of severe acute exacerbation and 1-year mortality in COPD wherever spirometry results are unavailable.

【 授权许可】

CC BY   
© The Author(s) 2023

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