Effect of inhaled anticholinergics on heart rate recovery in patients with stable chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

NIE Shan ,  YUAN Wei , WANG Haoyan , XU Qiufen , JIA Nan

Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P. R. China;

Corresponding?author：

YUAN Wei, Email: weiy_work@163.com

Keywords：

Chronic obstructive pulmonary disease; Tiotropium; Heart rate recovery

DOI：

10.7507/1671-6205.201805053

Video：

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Objective To investigate the effect of inhaled anticholinergics on heart rate recovery (HRR) in patients with stable chronic obstructive pulmonary disease (COPD). Methods Sixty clinically stable patients with stage Ⅱ-Ⅳ COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines were recruited. HRR was analyzed in this study between 28 patients who had received tiotropium≥1 year and 32 patients who never used anticholinergics as control, so as to reflect parasympathetic reactivity of the heart. Results HRR was significantly lower in the subjects with tiotropium than that in the controls [(16±6) beats/min vs. (22±8) beats/min, P<0.05]. Multivariate regression analysis revealed that anticholinergics medication could be used as an independent predictor of HRR in the COPD patients. Conclusion Anticholinergics can affect cardiac autonomic function of stable COPD patients.

Citation： NIE Shan, YUAN Wei, WANG Haoyan, XU Qiufen, JIA Nan. Effect of inhaled anticholinergics on heart rate recovery in patients with stable chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(6): 544-547. doi: 10.7507/1671-6205.201805053 Copy

1.	文富強. 2017 年慢性阻塞性肺疾病全球創議再解讀. 華西醫學, 2018, 33(1): 23-27.
2.	Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease (UPLIFT trial). N Engl J Med, 2008, 359(15): 1543-1554.
3.	Gershon A, Croxford R, Calzavara A, et al. Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease. JAMA Intern Med, 2013, 173(13): 1175-1184.
4.	Singh S, Loke YK, Enright P, et al. Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications. Thorax, 2013, 68(1): 114-116.
5.	Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA, 2008, 300(12): 1439-1450.
6.	Jardine DL, Charles CJ, Frampton CM, et al. Cardiac sympathetic nerve activity and ventricular fibrillation during acute myocardial infarction in a conscious sheep model. Am J Physiol Heart Circ Physiol, 2007, 293(1): H433-H439.
7.	Passariello G, Peluso A, Moniello G, et al. Effect of autonomic nervous system dysfunction on sudden death in ischemic patients with anginal syndrome died during electrocardiographic monitoring in Intensive Care Unit. Minerva Anestesiol, 2007, 73(4): 207-212.
8.	Cole CR, Blackstone EH, Pashkow FJ, et al. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med, 1999, 341(18): 1351-1357.
9.	劉海艦, 劉錦銘, 楊文蘭, 等. 運動試驗后心率恢復與穩定期慢性阻塞性肺疾病患者運動耐力的相關性研究. 中華全科醫師雜志, 2013, 12(1): 34-39.
10.	Hwangbo G, Lee DH, Park SH, et al. Changes in cardiopulmonary function according to posture during recovery after maximal exercise. J Phys Ther Sci, 2017, 29(7): 1163-1166.
11.	Arena R, Myers J, Aslam SS, et al. Peak VO₂ and VE/VCO₂ slope in patients with heart failure: a prognostic comparison. Am Heart J, 2003, 41(6): 354-360.
12.	Imai K, Sato H, Hori M, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol, 1994, 24(6): 1529-1535.
13.	Chhabra SK, De S. Cardiovascular autonomic neuropathy in chronic obstructive pulmonary disease. Respir Med, 2005, 99(1): 126-133.
14.	Lacasse M, Maltais F, Poirier P, et al. Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease. Respir Med, 2005, 99(7): 877-886.
15.	石萍, 喻洪流. 心率變異性的線性參數和非線性圖形特征在自主神經功能評價中的應用研究. 生物醫學工程學雜志, 2014, 31(2): 302-307.
16.	Wang X, Jiang Z, Chen B, et al. Cardiac autonomic function in patients with acute exacerbation of chronic obstructive pulmonary disease with and without ventricular tachycardia. BMC Pulm Med, 2016, 16(1): 124.
17.	Rodríguez DA, Kortianou EA, Alison JA, et al. Heart rate recovery after 6-min walking test predicts acute exacerbation in COPD. Lung, 2017, 195(4): 463-467.
18.	Wu YK, Huang CY, Yang MC, et al. Effect of tiotropium on heart rate variability in stable chronic obstructive pulmonary disease patients. J Aerosol Med Pulm Drug Deliv, 2015, 28(2): 100-105.

1. 文富強. 2017 年慢性阻塞性肺疾病全球創議再解讀. 華西醫學, 2018, 33(1): 23-27.
2. Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease (UPLIFT trial). N Engl J Med, 2008, 359(15): 1543-1554.
3. Gershon A, Croxford R, Calzavara A, et al. Cardiovascular safety of inhaled long-acting bronchodilators in individuals with chronic obstructive pulmonary disease. JAMA Intern Med, 2013, 173(13): 1175-1184.
4. Singh S, Loke YK, Enright P, et al. Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications. Thorax, 2013, 68(1): 114-116.
5. Singh S, Loke YK, Furberg CD. Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA, 2008, 300(12): 1439-1450.
6. Jardine DL, Charles CJ, Frampton CM, et al. Cardiac sympathetic nerve activity and ventricular fibrillation during acute myocardial infarction in a conscious sheep model. Am J Physiol Heart Circ Physiol, 2007, 293(1): H433-H439.
7. Passariello G, Peluso A, Moniello G, et al. Effect of autonomic nervous system dysfunction on sudden death in ischemic patients with anginal syndrome died during electrocardiographic monitoring in Intensive Care Unit. Minerva Anestesiol, 2007, 73(4): 207-212.
8. Cole CR, Blackstone EH, Pashkow FJ, et al. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med, 1999, 341(18): 1351-1357.
9. 劉海艦, 劉錦銘, 楊文蘭, 等. 運動試驗后心率恢復與穩定期慢性阻塞性肺疾病患者運動耐力的相關性研究. 中華全科醫師雜志, 2013, 12(1): 34-39.
10. Hwangbo G, Lee DH, Park SH, et al. Changes in cardiopulmonary function according to posture during recovery after maximal exercise. J Phys Ther Sci, 2017, 29(7): 1163-1166.
11. Arena R, Myers J, Aslam SS, et al. Peak VO₂ and VE/VCO₂ slope in patients with heart failure: a prognostic comparison. Am Heart J, 2003, 41(6): 354-360.
12. Imai K, Sato H, Hori M, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol, 1994, 24(6): 1529-1535.
13. Chhabra SK, De S. Cardiovascular autonomic neuropathy in chronic obstructive pulmonary disease. Respir Med, 2005, 99(1): 126-133.
14. Lacasse M, Maltais F, Poirier P, et al. Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease. Respir Med, 2005, 99(7): 877-886.
15. 石萍, 喻洪流. 心率變異性的線性參數和非線性圖形特征在自主神經功能評價中的應用研究. 生物醫學工程學雜志, 2014, 31(2): 302-307.
16. Wang X, Jiang Z, Chen B, et al. Cardiac autonomic function in patients with acute exacerbation of chronic obstructive pulmonary disease with and without ventricular tachycardia. BMC Pulm Med, 2016, 16(1): 124.
17. Rodríguez DA, Kortianou EA, Alison JA, et al. Heart rate recovery after 6-min walking test predicts acute exacerbation in COPD. Lung, 2017, 195(4): 463-467.
18. Wu YK, Huang CY, Yang MC, et al. Effect of tiotropium on heart rate variability in stable chronic obstructive pulmonary disease patients. J Aerosol Med Pulm Drug Deliv, 2015, 28(2): 100-105.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of inhaled anticholinergics on heart rate recovery in patients with stable chronic obstructive pulmonary disease

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