Chronotropic incompetence predicts mortality in severe obstructive pulmonary disease

José González-Costello, Hilary F. Armstrong, Ulrich P. Jorde, Anna C. Bevelaqua, Laurie Letarte, Byron M. Thomashow, Matthew N. Bartels

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


We evaluated the prevalence of chronotropic incompetence (CI), a marker of autonomic dysfunction, and its prognostic value in patients with chronic obstructive pulmonary disease (COPD). We performed a retrospective analysis of 449 patients with severe COPD who underwent a cardiopulmonary exercise test, after excluding patients with lung volume reduction surgery, left ventricular dysfunction and those not in sinus rhythm. CI was defined as percent predicted heart rate reserve (%HRR). Events were defined as death or lung transplant during a median follow-up of 68 months. Median age was 61 years; median percent predicted forced expiratory volume in one second (%FEV1) of 25% and median %HRR of 33%. The hazard ratio for an event in the lowest quartile of %HRR, taking the highest quartile as reference, was of 3.2 (95% confidence interval: 2.1-4.8; p<0.001). In a multivariate regression model, %HRR was an independent predictor of events. In conclusion, CI was an independent and powerful outcome predictor in patients with severe COPD.

Original languageEnglish (US)
Pages (from-to)113-118
Number of pages6
JournalRespiratory Physiology and Neurobiology
Issue number2
StatePublished - Aug 15 2013
Externally publishedYes


  • Chronic obstructive pulmonary disease
  • Chronotropic incompetence
  • Heart rate reserve

ASJC Scopus subject areas

  • Neuroscience(all)
  • Physiology
  • Pulmonary and Respiratory Medicine


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