单位：[1]Rehabilitation Clinical Trials Center,Division of Respiratory and Critical CarePhysiology and Medicine, The LundquistInstitute for Biomedical Innovation atHarbor-UCLA Medical Center, Torrance,CA, USA[2]State Key Laboratory ofRespiratory Disease, National ClinicalResearch Center for Respiratory Disease,Guangzhou Institute of Respiratory Health,The First Affiliated Hospital of GuangzhouMedical University, Guangzhou, Guangdong,510120, People’s Republic of China[3]Department of Kinesiology, University ofRhode Island, Kingston, RI, USA[4]Respiratory Medicine Department, BeijingFriendship Hospital Affiliated of CapitalMedical University, Beijing, 100050, People’sRepublic of China临床科室呼吸内科呼吸内科首都医科大学附属北京友谊医院[5]MemorialCare LongBeach Medical Center, Long Beach, CA,USA[6]Division of Pulmonary, Allergy,Critical Care and Sleep Medicine, Universityof Minnesota, Minneapolis, MN, USA[7]Minneapolis VA Health Care System,Minneapolis, MN, USA[8]National JewishHealth, Denver, CO, USA
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.
基金：
National Heart, Lung, and Blood InstituteUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [NIH/NHLBI R01HL089897, R01HL089856, U01HL089897, U01HL089856]
第一作者单位：[1]Rehabilitation Clinical Trials Center,Division of Respiratory and Critical CarePhysiology and Medicine, The LundquistInstitute for Biomedical Innovation atHarbor-UCLA Medical Center, Torrance,CA, USA[2]State Key Laboratory ofRespiratory Disease, National ClinicalResearch Center for Respiratory Disease,Guangzhou Institute of Respiratory Health,The First Affiliated Hospital of GuangzhouMedical University, Guangzhou, Guangdong,510120, People’s Republic of China
通讯作者：
推荐引用方式(GB/T 7714)：
Dongxing Zhao,Asghar Abbasi,Richard Casaburi,et al.Identifying a Heart Rate Recovery Criterion After a 6-Minute Walk Test in COPD[J].INTERNATIONAL JOURNAL of CHRONIC OBSTRUCTIVE PULMONARY DISEASE.2021,16:2545-2560.doi:10.2147/COPD.S311572.
APA：
Dongxing Zhao,Asghar Abbasi,Richard Casaburi,Alessandra Adami,Nicholas B Tiller...&Harry B Rossiter.(2021).Identifying a Heart Rate Recovery Criterion After a 6-Minute Walk Test in COPD.INTERNATIONAL JOURNAL of CHRONIC OBSTRUCTIVE PULMONARY DISEASE,16,
MLA：
Dongxing Zhao,et al."Identifying a Heart Rate Recovery Criterion After a 6-Minute Walk Test in COPD".INTERNATIONAL JOURNAL of CHRONIC OBSTRUCTIVE PULMONARY DISEASE 16.(2021):2545-2560
