Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease Treated by Noninvasive Mechanic Ventilation

Öz

Aims: This study aimed to investigate heart rate variability (HRV) of patients with severe COPD who are treated by noninvasive mechanic ventilation (NIMV). Patients and Method: Twenty-seven patient (58±8 years, 9 F) with severe COPD treated by nocturnal NIMV at home and 23 sex and age matched volunteYusuf ers (56±8 years, 11 F) who has not dyspnea as a control group recruited in the study. Subjects underwent spirometry, blood gas analysis, transthoracic echocardiography, 24 hours ambulatory ECG analysis. Time domain HRV analysis performed from ambulatory ECG records. Results: 52% of patients at NYHA functional class II, 36% at class III, and 12% at class IV when they have been treated by NIMV. Groups were similar for age and sex (p>0.05 for both). Heart rates of patients were higher significantly than controls' (p0.05). But, systolic pulmonary pressures were higher of COPD group (p

Anahtar Kelimeler

• Chronic Obstructive Pulmonary Disease, Noninvasive Mechanic Ventilation, Heart Rate Variability.

Noninvaziv Mekanik Ventilatör Kullanan Kronik Obstrüktif Akciğer Hastalıklı Hastalarda Kalp Hızı Değişkenliği

Öz

Amaç: Bu çalışmada kronik solunum yetmezliği nedeni ile uzun dönem noninvaziv mekanik ventilasyon (NİMV) uygulanan ileri solumnum yetersizlikli KOAH hastalarının kalp hızı değişkenliği (KHD) araştırıldı. Hastalar ve Metod: Evde uzun dönem noktürnal NİMV kullanan sinüs ritminde 27 çok ağır KOAH hastası (58±8 yaş, 9 K) ile kontrol grubu olarak yaş ve cinsiyet olarak eşleştirilmiş solunum sıkıntısı olmayan 23 gönüllü (56±8 yaş, 11 K) çalışmaya alındı. Olgulara solunum fonksiyon testi, arter kan gazı analizi, transtorasik ekokardiyografi, 24 saatlik ambulatuvar elektrokardiyografi incelemesi yapıldı. Ambulatuvar EKG kaydında zaman-alan KHD analizi yapıldı. Bulgular: NİMV kullanırken hastaların %52'si NYHA fonksiyonel kapasite sınıf II, %36'sı sınıf III, %12'si sınıf IV idi. Hasta grubu yaş ve cins yönünden kontrol grubuyla benzerdi (her ikisi için de p>0.05). KOAH olgularının kalp hızı anlamlı yüksek (p0.05), sistolik pulmoner arter basıncı ise KOAH olgularında anlamlı olarak yüksek (p

Anahtar Kelimeler

• Kronik Obstriktif Akciğer Hastalığı, Noninvaziv Mekanik Ventilasyon, Kalp Hızı Değişkenliği.

Kaynakça

1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.
2. Anthonisen NR, Connett JE, Enright PL, Manfreda J; Lung Health Study Research Group. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002;166,333-9.
3. Rutten FH, Cramer MJ, Grobbee DE, Sachs AP, Kirkels JH, Lammers JW, et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J 2005;26,1887-94.
4. Antonelli Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997;10:2794-800.
5. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation 1998;98:1510-6.
6. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987;59:256-62.
7. Cheng YJ, Lauer MS, Earnest CP, Church TS, Kampert JB, Gibbons LW, et al. Heart rate recovery following maximal exercise testing as a predictor of cardiovascular disease and all-cause mortality in men with diabetes. Diabetes Care 2003;26:2052-7.
8. Singh JP, Larson MG, Tsuji H, Evans JC, O'Donnell CJ, Levy D. Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension: the Framingham Heart Study. Hypertension 1998;32:293-7.

9. Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996;94:2850-5.
10. Sin DD, Wong E, Mayers I, Lien DC, Feeny D, Cheung H, et al. Effects of Nocturnal Noninvasive Mechanical Ventilation on Heart Rate Variability of Patients With Advanced COPD. Chest 2007;131:156-63.
11. Stein PK, Nelson P, Rottman JN, Howard D, Ward SM, Kleiger RE, et al. Heart rate variability reflects severity of COPD in PiZ alpha1-antitrypsin deficiency. Chest 1998;113:327-33.
12. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817-22.
13. Clini E, Sturani C, Rossi A Viaggi S, Corrado A, Donner CF, et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients (AIPO). Eur Respir J 2002;20:529-38.
14. Yazici M, Uzun K, Ulgen MS, Teke T, Maden E, Kayrak M, et al. The acute effect of bi-level positive airway pressure on heart rate variability in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure. Anadolu Kardiyol Derg 2008;8:426-30.
15. American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995;152:1107-36.
16. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004;17:1086-119.
17. Task Force of the European Society of Cardiology and The North American Society of Pacing Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 1996;93:1043-65.
18. Renston JP, DiMarco AF, Supinski GS. Respiratory muscle rest using nasal BiPAP ventilation in patients with stable severe COPD. Chest 1994;105:1053-60.
19. Goldberg P, Reissmann H, Maltais F, Ranieri M, Gottfried SB. Efficacy of noninvasive CPAP in COPD with acute respiratory failure. Eur Respir J, 1995;8:1894-900.
20. Appendini L, Patessio A, Zanaboni S, Carone M, Gukov B, Donner CF, et al. Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994;149:1069-76.
21. Meecham Jones DJ, Paul EA, Jones PW, Wedzicha JA. Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD. Am J Respir Crit Care Med 1995;152:538-44.
22. Garrod R, Mikelsons C, Paul EA, Wedzicha JA. Randomized kontrolled trial of domiciliary noninvasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;162:1335-41.
23. Bergofsky EH. Respiratory failure in disorders of the thoracic cage. Am Rev Respir Dis 1979;119:643-69.
24. Heindl S, Lehnert M, Criée CP, Hasenfuss G, Andreas S. Marked sympathetic activation in patients with chronic respiratory failure. Am J Respir Crit Care Med 2001;164:597-601.
25. Brown SJ, Howden R. The effects of a respiratory acidosis on human heart rate variability. Adv Exp Med Biol 2008;605:361-5.
26. Tukek T, Yildiz P, Atilgan D, Tuzcu V, Eren M, Erk O, et al. Effect of diurnal variability of heart rate on development of arrhythmia in patients with chronic obstructive pulmonary disease. Int J Cardiol 2003;88:199-206.
27. Tug T, Terzi SM, Yoldas TK. Relationship between the frequency of autonomic dysfunction and the severity of chronic obstructive pulmonary disease. Acta Neurol Scand 2005;112:183-8.
28. Naughton MT, Benard DC, Liu PP, Rutherford R, Rankin F, Bradley TD. Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med 1995;152:473–9.
29. Raupach T, Bahr F, Herrmann P, Luethje L, Heusser K, Hasenfuss G, et al. Slow breathing reduces sympathoexcitation in COPD. Eur Respir J 2008;32:387-92.
30. Tkacova R, Dajani HR, Rankin F, Fitzgerald FS, Floras JS, Douglas Bradley T. Continuous positive airway pressure improves nocturnal baroreflex sensitivity of patients with heart failure and obstructive sleep apnea. J Hypetens 2000;18:1257-62.
31. Wong ND, Cupples LA, Ostfeld AM, Levy D, Kannel WB. Risk factors for long-term coronary prognosis after initial myocardial infarction: the Framingham Study. Am J Epidemiol 1989;130:469-80.
32. Beaty TH, Newill CA, Cohen BH, Tockman MS, Bryant SH, Spurgeon HA. Effects of pulmonary function on mortality. J Chronic Dis 1985;38:703–10.
33. Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005;2:8-11.