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Chronotropic Incompetence in Patients Before Lung Cancer Surgery
PDPI Surakarta, 28 Nov 2019 13:04:04

Abstract

Introduction: Cardiopulmonary exercise testing (CPX) is a standard part of preoperative evaluation in patients before surgical lung resections. According to current guidelines the risk of such a procedure is estimated according to peak oxygen consumption (VO2peak). Chronotropic incompetence (CI) is a prevalent condition which could possibly influence cardiopulmonary fitness. The aim of this study is to assess prevalence of CI and its influence on CPX results.

Material and Methods: This study enrolled 154 patients (97 men) with newly diagnosed lung cancer indicated for surgical lung resections. All patients underwent cardiopulmonary exercise testing (cycle ergometry). Age predicted maximal HR was calculated using the traditional equation (220 – age). Three levels of chronotropic incompetence were defined as, 85% HRpred, 80% HRpred and 70% HRpred. The influence of CI on CPX results was evaluated.

Results: Chronotropic incompetence was present in the following ratios: 85% HRpred – 48.7%; 80% HRpred – 39.6% and 70% HRpred – 16.9%. The presence of chronotropic incompetence significantly correlated with beta-blocker treatment (p<0.0001). A significant negative correlation was also found between VO2peak, maximal heart rate and maximal work load among all chronotropic incompetence groups (p<0.0001).

Conclusion: Chronotropic incompetence significantly decreases VO2peak in patients before lung cancer surgery. It is thus a matter for future discussion, as to whether the evaluation of chronotropic incompetence should be part of preoperative care guidelines.

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