Abstract
The objective of this study was to investigate the impact of chronic obstructive pulmonary disease (COPD)-heart failure (HF) coexistence on linear and nonlinear dynamics of heart rate variability (HRV). Forty-one patients (14 with COPD-HF and 27 HF) were enrolled and underwent pulmonary function and echocardiography evaluation to confirm the clinical diagnosis. Heart rate (HR) and R-R intervals (iRR) were collected during active postural maneuver (APM) [supine (10 min) to orthostasis (10 min)], respiratory sinus arrhythmia maneuver (RSA-M) (4 min), and analysis of frequency domain, time domain, and nonlinear HRV. We found expected autonomic response during orthostatic changes with reduction of mean iRR, root mean square of successive differences between heart beats (RMSSD), RR tri index, and high-frequency [HF (nu)] and an increased mean HR, low-frequency [LF (nu)], and LF/HF (nu) compared with supine only in HF patients (P<0.05). Patients with COPD-HF coexistence did not respond to postural change. In addition, in the orthostatic position, higher HF nu and lower LF nu and LF/HF (nu) were observed in COPD-HF compared with HF patients. HF patients showed an opposite response during RSA-M, with increased sympathetic modulation (LF nu) and reduced parasympathetic modulation (HF nu) (P<0.05) compared with COPD-HF patients. COPD-HF directly influenced cardiac autonomic modulation during active postural change and controlled breathing, demonstrating an autonomic imbalance during sympathetic and parasympathetic maneuvers compared with isolated HF.
Highlights
The coexistence of chronic obstructive pulmonary disease (COPD) in patients with heart failure (HF) leads to severe impairments in functional capacity [1] and quality of life, and both diseases have important systemic components that affect autonomic adjustments and functioning of several systems, such as cardiovascular control at rest and during exercise [2,3]
The cardiovascular system and the mechanisms that regulate autonomic adjustments can be investigated by analyzing heart rate variability (HRV), which represents a powerful tool for research capable of identifying increased mortality risk and poor prognosis [4]
HRV indices in active postural maneuver (APM) We found expected autonomic response during orthostasis with reduction of mean iRR, RMSSD, RR triindex, and HF nu and an increase in mean HR, LF nu, and LF/HF nu compared with supine (Po0.05) only in HF patients
Summary
The coexistence of chronic obstructive pulmonary disease (COPD) in patients with heart failure (HF) leads to severe impairments in functional capacity [1] and quality of life, and both diseases have important systemic components that affect autonomic adjustments and functioning of several systems, such as cardiovascular control at rest and during exercise [2,3]. Limitations in cardiac function compromise the transport of nutrients and metabolic products from the organic system and cause sympathetic hyperactivity and consequent decrease in vagal tone [6]. These patients may present with chronic hypoxemia of the peripheral tissue, which is capable of modifying the control by central and peripheral chemoreceptors [7]. COPD has a major impact on systemic manifestations such as attenuated HRV responses, increased sympathetic activity, and resting heart rate (HR) These responses may be related to marked parasympathetic airway hyperactivity, bronchoconstriction and vasoconstriction, hypoxemia, hypercapnia, and systemic inflammation [8,9,10]. Zangrando et al [11] found that autonomic modulation during active postural maneuver (APM) was impaired
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