Heart Rate Variability Reflects Severity of COPD in PiZ ₁-Antitrypsin Deficiency

¹ From the Division of Cardiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis
² From the Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis

Background: Analysis of heart rate variability (HRV) is a powerful method of assessing severity of conditions affecting the autonomic nervous system.

Study objective: To determine if HRV is decreased and if HRV reflects severity in COPD.

Design: Prospective determination of HRV from 24-h outpatient Holter recordings.

Patients: Eighteen individuals with PiZ ₁-antitrypsin deficiency: 13 with COPD and 5 with normal FEV₁ HRV was also determined in 18 matched normal control subjects. Approximately 3 years after the initial recording, all COPD subjects were contacted to determine current status.

Measurements: Indexes of heart rate (HR) and HRV were compared for groups of patients with and without COPD and their control subjects.

Results: Mean and minimum HRs were higher in COPD patients. Virtually all indexes of HRV were significantly decreased in COPD patients. No differences were found in HR or HRV between PiZ individuals with normal FEV₁ and their age- and gender-matched control subjects. Patients who had a change in status (ie, death, lung transplant, listed for transplant) had significantly higher daytime HRs, lower values for HRV indexes reflecting mixed sympathetic and parasympathetic modulation of HR, and reduced daytime high-frequency spectral power, an index of cardiac vagal modulation. Significant correlations (r=0.48 to 0.88) were found between FEV₁ and these and other indexes of HRV. Most other indexes of HRV also tended to be lower for the group whose status had changed.

Conclusion: PiZ ₁-antitrypsin deficiency COPD is associated with abnormal cardiac autonomic modulation. Indexes of HRV appear to reflect severity and may have prognostic value in COPD patients.

Key Words: autonomic nervous system • heart rate variability • pulmonary disease • risk factors

Submitted on March 21, 1997
Accepted on July 28, 1000

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