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Chronotropic Index and Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Secondary Analysis of BLOCK

David M MacDonald1, Erika S Helgeson2, Selcuk Adabag3

  • 1Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, and.

Annals of the American Thoracic Society
|March 30, 2021
PubMed

Insights

A higher chronotropic index during a 6-minute walk (CI-6MW) is linked to a reduced risk of acute exacerbations in chronic obstructive pulmonary disease (AECOPD). However, metoprolol use can negate this protective effect, indicating potential susceptibility to adverse drug reactions.

Area of Science:

  • Cardiology
  • Pulmonology
  • Clinical Trials

Background:

  • The chronotropic index (CI) measures heart rate response to exercise.
  • The association between CI and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is unknown.
  • Chronic obstructive pulmonary disease (COPD) management requires understanding exacerbation triggers and patient risk factors.

Purpose of the Study:

  • To investigate if a higher chronotropic index during a 6-minute walk (CI-6MW) correlates with a reduced risk of AECOPD.
  • To determine if CI-6MW can predict susceptibility to metoprolol's adverse effects in COPD patients.

Main Methods:

  • Analysis of data from the BLOCK COPD trial.
  • Utilized Cox proportional hazards models to assess the relationship between CI-6MW and time to AECOPD.
  • Examined interactions between metoprolol treatment and CI-6MW on AECOPD risk.

Main Results:

  • Higher CI-6MW was independently associated with a decreased risk of any-severity AECOPD (aHR 0.88 per 0.1 increase).
  • No significant association was found between CI-6MW and hospitalization-requiring AECOPDs (aHR 0.94).
  • A significant interaction revealed metoprolol negated the protective effect of a higher CI-6MW on AECOPDs.

Conclusions:

  • A higher CI-6MW is associated with a lower risk of AECOPD in COPD patients.
  • CI-6MW may serve as a biomarker for identifying COPD patients susceptible to metoprolol's adverse effects.
  • Further research is warranted to explore the clinical implications of CI-6MW in COPD management and beta-blocker therapy.

Keywords:
cardiac chronotropychronic obstructivedisease exacerbationpulmonary disease

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