The prognostic significance of lung function in stable heart failure outpatients

TY - JOUR

T1 - The prognostic significance of lung function in stable heart failure outpatients

AU - Plesner, Louis Lind

AU - Dalsgaard, Morten

AU - Schou, Morten

AU - Køber, Lars

AU - Vestbo, Jørgen

AU - Kjøller, Erik

AU - Iversen, Kasper

N1 - © 2017 Wiley Periodicals, Inc.

PY - 2017/11

Y1 - 2017/11

N2 - Background: This study investigated the impact on all-cause mortality of airflow limitation indicative of chronic obstructive pulmonary disease or restrictive spirometry pattern (RSP) in a stable systolic heart failure population. Hypothesis: Decreased lung function indicates poor survival in heart failure. Methods: Inclusion criteria: NYHA class II-IV and left ventricular ejection fraction (LVEF) < 45%. Prognosis was assessed with multivariate Cox proportional hazards models. Two criteria of obstructive airflow limitation were applied: FEV1/FVC < 0.7 (GOLD), and FEV1/FVC < lower limit of normality (LLN). RSP was defined as FEV1/FVC > 0.7 and FVC<80% or FEV1/FVC > LLN and FVC <LLN. Results: There where 573 patients in the cohort (85% of eligible patients in study period). Median follow-up was 4.7 years and 176 patients died (31%). Age, NYHA class, smoking, body mass index and LVEF were independent prognostic factors (p<0.01). Obstructive airflow limitation increased mortality using both criteria (HRGOLD 2.07 [95% CI 1.45–2.95] p<0.01 and HRLLN 2.00 [1.40–2.84] p<0.01) and was an independent marker when using LLN criteria (HR 1.74 [1.17-2.59] p=0.006). RSP was independently associated with mortality when defined as FVC < LLN (HR 1.54 [1.01–2.35] p=0.04) but not as FVC < 80%. Multivariate hazard ratios for a 10% decrease in predicted value of FEV1 or FVC were 1.42 (p<0.001) and 1.33 (p<0.001) in patients exhibiting airflow obstruction, and 1.36 (p=0.031) and 1.38 (p=0.041) in RSP. Conclusions: Presence of obstructive airflow limitation indicative of COPD or RSP were associated with increased all-cause mortality, however only independently when using the LLN definition.

AB - Background: This study investigated the impact on all-cause mortality of airflow limitation indicative of chronic obstructive pulmonary disease or restrictive spirometry pattern (RSP) in a stable systolic heart failure population. Hypothesis: Decreased lung function indicates poor survival in heart failure. Methods: Inclusion criteria: NYHA class II-IV and left ventricular ejection fraction (LVEF) < 45%. Prognosis was assessed with multivariate Cox proportional hazards models. Two criteria of obstructive airflow limitation were applied: FEV1/FVC < 0.7 (GOLD), and FEV1/FVC < lower limit of normality (LLN). RSP was defined as FEV1/FVC > 0.7 and FVC<80% or FEV1/FVC > LLN and FVC <LLN. Results: There where 573 patients in the cohort (85% of eligible patients in study period). Median follow-up was 4.7 years and 176 patients died (31%). Age, NYHA class, smoking, body mass index and LVEF were independent prognostic factors (p<0.01). Obstructive airflow limitation increased mortality using both criteria (HRGOLD 2.07 [95% CI 1.45–2.95] p<0.01 and HRLLN 2.00 [1.40–2.84] p<0.01) and was an independent marker when using LLN criteria (HR 1.74 [1.17-2.59] p=0.006). RSP was independently associated with mortality when defined as FVC < LLN (HR 1.54 [1.01–2.35] p=0.04) but not as FVC < 80%. Multivariate hazard ratios for a 10% decrease in predicted value of FEV1 or FVC were 1.42 (p<0.001) and 1.33 (p<0.001) in patients exhibiting airflow obstruction, and 1.36 (p=0.031) and 1.38 (p=0.041) in RSP. Conclusions: Presence of obstructive airflow limitation indicative of COPD or RSP were associated with increased all-cause mortality, however only independently when using the LLN definition.

KW - Journal Article

U2 - 10.1002/clc.22802

DO - 10.1002/clc.22802

M3 - Journal article

C2 - 28902960

SN - 0160-9289

VL - 40

SP - 1145

EP - 1151

JO - Clinical Cardiology

JF - Clinical Cardiology

IS - 11

ER -