Rutten Frans H, Cramer Maarten-Jan M, Lammers Jan-Willem J, Grobbee Diederick E, Hoes Arno W
Utrecht Heart Failure Organisation (UHFO), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85060, Stratenum 6.101, 3508 AB Utrecht, the Netherlands.
Eur J Heart Fail. 2006 Nov;8(7):706-11. doi: 10.1016/j.ejheart.2006.01.010. Epub 2006 Mar 13.
To quantify the prevalence of heart failure and left ventricular systolic dysfunction (LVSD) in chronic obstructive pulmonary disease (COPD) patients and vice versa. Further, to discuss diagnostic and therapeutic implications of the co-existence of both syndromes.
We performed a Medline search from 1966 to March 2005. The reported prevalence of LVSD among COPD patients varied considerably, with the highest prevalence (10-46%) among those with an exacerbation. One single study assessed the prevalence of heart failure in COPD patients. A prevalence of 21% of previously unknown heart failure was reported in patients with a history of COPD or asthma. We did not find any report on COPD in heart failure or LVSD patients. Diagnosing heart failure in COPD patients or vice versa is complicated by overlap in signs and symptoms, and diminished diagnostic value of additional investigations. In general, pulmonary and heart failure 'drug cocktails' can be administered safely to patients with concomitant COPD and heart failure, although (short acting) beta2-adrenoreceptor agonists and digitalis have potentially deleterious effects on cardiac and pulmonary function, respectively.
Although knowledge about the prevalence of concomitant heart failure in COPD patients and vice versa is scarce, it seems that the combined presence is rather common. In view of diagnostic and therapeutic implications, more attention should be paid to the concomitant presence of both syndromes in clinical practice and research.
量化慢性阻塞性肺疾病（COPD）患者中心力衰竭和左心室收缩功能障碍（LVSD）的患病率，反之亦然。此外，探讨两种综合征并存的诊断和治疗意义。
我们对1966年至2005年3月期间的医学文献数据库进行了检索。报道的COPD患者中LVSD的患病率差异很大，其中病情加重患者的患病率最高（10 - 46%）。仅有一项研究评估了COPD患者中心力衰竭的患病率。据报道，有慢性阻塞性肺疾病或哮喘病史的患者中，既往未知心力衰竭的患病率为21%。我们未找到关于心力衰竭或LVSD患者中COPD情况的任何报告。COPD患者中诊断心力衰竭或反之亦然会因体征和症状重叠以及其他检查的诊断价值降低而变得复杂。一般来说，虽然（短效）β2肾上腺素能受体激动剂和洋地黄分别对心脏和肺功能有潜在有害影响，但肺部和心力衰竭的“药物组合”可安全地给予COPD和心力衰竭并存的患者。
尽管关于COPD患者中并存心力衰竭的患病率以及反之亦然的情况了解甚少，但似乎两者并存相当常见。鉴于诊断和治疗意义，临床实践和研究中应更加关注这两种综合征的并存情况。
