Myocardial Infarction Injury in Patients with Chronic Lung Disease Entering Pulmonary Rehabilitation: Frequency and Association with Heart Rate Parameters

Carmen A Sima; Benny C Lau; Carolyn M Taylor; Stephan F van Eeden; W Darlene Reid; Andrew W Sheel; Ashley R Kirkham; Pat G Camp

doi:10.1016/j.pmrj.2018.03.005

Myocardial Infarction Injury in Patients with Chronic Lung Disease Entering Pulmonary Rehabilitation: Frequency and Association with Heart Rate Parameters

PM R. 2018 Sep;10(9):917-925. doi: 10.1016/j.pmrj.2018.03.005. Epub 2018 Mar 14.

Authors

Carmen A Sima¹, Benny C Lau², Carolyn M Taylor³, Stephan F van Eeden⁴, W Darlene Reid⁵, Andrew W Sheel⁶, Ashley R Kirkham⁷, Pat G Camp⁸

Affiliations

¹ Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada(∗).
² Providence Health Care, University of British Columbia, Vancouver, Canada; Vancouver Coastal Health, Division of Cardiology, University of British Columbia, Vancouver, Canada(†).
³ Providence Health Care, University of British Columbia, Vancouver, Canada; Division of Cardiology, University of British Columbia, Vancouver, Canada(‡).
⁴ Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada; Providence Health Care, University of British Columbia, Vancouver, Canada; Department of Internal Medicine, University of British Columbia, Vancouver, Canada(§).
⁵ Department of Physical Therapy, University of Toronto, Toronto, Canada(¶).
⁶ School of Kinesiology, University of British Columbia, Vancouver, Canada(#).
⁷ Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada(∗∗).
⁸ Centre for Heart Lung Innovation, University of British Columbia, St. Paul's Hospital, Room 166, 1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada; Providence Health Care, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada(††). Electronic address: pat.camp@hli.ubc.ca.

PMID: 29550408
DOI: 10.1016/j.pmrj.2018.03.005

Abstract

Background: Myocardial infarction (MI) remains under-recognized in chronic lung disease (CLD) patients. Rehabilitation health professionals need accessible clinical measurements to identify the presence of prior MI in order to determine appropriate training prescription.

Objectives: To estimate prior MI in CLD patients entering a pulmonary rehabilitation program, as well as its association with heart rate parameters such as resting heart rate and chronotropic response index.

Design: Retrospective cohort design.

Setting: Pulmonary rehabilitation outpatient clinic in a tertiary care university-affiliated hospital.

Patients: Eighty-five CLD patients were studied.

Methods: Electrocardiograms at rest and peak cardiopulmonary exercise testing, performed before pulmonary rehabilitation, were analyzed. Electrocardiographic evidence of prior MI, quantified by the Cardiac Infarction Injury Score (CIIS), was contrasted with reported myocardial events and then correlated with resting heart rate and chronotropic response index parameters.

Main outcome measurements: CIIS, resting heart rate, and chronotropic response index.

Results: Sixteen CLD patients (19%) demonstrated electrocardiographic evidence of prior MI, but less than half (8%) had a reported MI history (P < .05). The Cohen's kappa test revealed poor level of agreement between CIIS and medical records (kappa = 0.165), indicating that prior MI diagnosis was under-reported in the medical records. Simple and multiple regression analyses showed that resting heart rate but not chronotropic response index was positively associated with CIIS in our population (R² = 0.29, P < .001). CLD patients with a resting heart rate higher than 80 beats/min had approximately 5 times higher odds of having prior MI, as evidenced by a CIIS ≥ 20.

Conclusions: CLD patients entering pulmonary rehabilitation are at risk of unreported prior MI. Elevated resting heart rate appears to be an indicator of prior MI in CLD patients; therefore, careful adjustment of training intensity is recommended under these circumstances.

Level of evidence: III.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chronic Disease
Electrocardiography*
Exercise Test
Female
Follow-Up Studies
Heart Rate / physiology*
Humans
Lung Diseases / complications
Lung Diseases / physiopathology
Lung Diseases / rehabilitation*
Male
Middle Aged
Myocardial Infarction / diagnosis
Myocardial Infarction / etiology
Myocardial Infarction / physiopathology*
Outpatient Clinics, Hospital / statistics & numerical data*
Prognosis
Rehabilitation Centers*
Retrospective Studies