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Table 1 Main studies about the influences of chronic obstructive pulmonary disease on cardiac autonomic control

From: Chronic obstructive pulmonary disease and heart rate variability: a literature update

Selected articles Principal outcomes Score Pedro
Van gestel et al., 2011 [13] We studied 60 patients with COPD and measured HRQL, as assessed by the Chronic Respiratory Disease Questionnaire, and cardiac autonomic dysfunction, as assessed by heart rate variability (HRV). Analysis of HRV was performed using a Holter-ECG device during a recording period of 5 min. To evaluate a possible association between these factors, univariate and multivariate analyses were used. Resting parasympathetic tone, as measured by HRV, is independently associated with HRQL, which emphasizes the role of cardiac autonomic dysfunction on HRQL in patients with COPD. 3/10
Gunduz et al., 2009 [14] Twenty five moderate to severe COPD patients and 25 healthy subjects were included in this study. Pulmonary function tests and echocardiographic examination, arterial blood gases analysis were performed; HRV and HRT analysis were assessed from a 24-hour Holter recording. In addition to HRV parameters, HRT onset was significantly different in COPD patients. In our opinion, the combination of HRV variables and HRT onset may be simple and elegant ways of evaluating cardiac autonomic functions. 3/10
Cheng et al., 2014 [15] Sixty-four patients with COPD participated in a 12-week, 2 sessions-per-week, hospital-based PR program. Baseline and post-PR status were evaluated by spirometry, HRV, health-related quality of life, cardiopulmonary exercise test, respiratory muscle strength, and dyspnea Borg's scale. PR results in significant improvements in autonomic function, with concurrent improvements in HRQL and exercise capacity. 4/10
Suh et al., 2013 [16] The study utilized a 2 (disease status) × 2 (anxiety group) factorial design examining HRV associated with anxiety symptoms and COPD during a standardized acute social stress task. 30 COPD patients were age- and gender-matched with 30 healthy controls. Anxiety is associated with dysregulated HRV response to a psychosocial stressor, but the negative influence of anxiety and COPD on autonomic function did not appear to be additive. Comorbid anxiety in patients with COPD is associated with increased behavioral and psychological symptoms of distress. 5/10
Dias de Carvalho et al., 2011 [17] We evaluated geometric index of HRV in COPD subjects. We analyzed data from 34 volunteers, divided into two groups according to spirometric values: COPD and control. For analysis of HRV indexes the volunteers remained in the supine position for 30 minutes. Subjects with COPD present reduction of geometric indexes of HRV, indicating reduced heart rate variability. 6/10
Mendes et al., 2011 [18] To analyze the behavior of heart rate (HR), blood pressure (BP) and heart rate variability (HRV) during the FVC test in COPD patients. Nineteen men with COPD performed the FVC test while having their HR monitored. HRV was assessed in time and frequency domains at rest, before and after the best FVC maneuver. BP was measured at rest, immediately before and at the end of the test, as well as 10 minutes after the end of the test. The FVC test influences the behavior of COPD patient HR without changing autonomic control or BP. 4/10
Camillo ca et al., 2011 [19] We aimed to investigate changes in HRV after two exercise training programs in patients with COPD. Forty patients with COPD were randomized into high (n = 20) or low (n = 20) intensity exercise training (3-month duration), and had their HRV assessed by the head-up tilt test before and after either protocols. High-intensity exercise training improves HRV at rest and during orthostatic stimulus in patients with COPD. 5/10
Carvalho et al., 2011 [20] We analyzed data from 30 volunteers, who were divided into two groups according to spirometric values: COPD (n = 15) and control (n = 15). For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 30 minutes. COPD subjects present reduced short-term fractal correlation properties of HRV, which indicates that this index can be used for risk stratification, assessment of systemic disease manifestations, and therapeutic procedures to monitor those patients. 5/10
Reis et al., 2010 [21] Ten COPD patients and nine age-matched healthy volunteers participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph. Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. 3/10
Borghi-Silva et al., 2009 [22] Forty patients of both sexes with moderate-to-severe COPD were randomly allocated to aerobic exercise training (PT, n = 20) or to usual care (Control, n = 20). The training program consisted of lower and upper limb stretching and 30 min of treadmill exercise, 3 times per week for a 6-week period. The improvement in submaximal performance after exercise training was associated with parasympathetic activity. 4/10
Antonelli Incalzi et al., 2009 [23] We studied 54 patients with COPD. Heart rate variability (HRV) was assessed based on 24-h Holter ECG recording. Sympathetic modulation decreased for increasing severity of COPD. In conclusion, drawing impairment correlates with depressed sympathetic modulation in patients with COPD, and both might be indexes of COPD severity. 3/10