慢性阻塞性肺疾病严重程度对射血分数降低型心力衰竭患者症状和预后的影响。
Impact of chronic obstructive pulmonary disease severity on symptoms and prognosis in patients with systolic heart failure.
机构信息
Department of Cardiology, University Hospital of Rangueil, Toulouse Cedex, France.
出版信息
Clin Res Cardiol. 2012 Sep;101(9):717-26. doi: 10.1007/s00392-012-0450-4. Epub 2012 Apr 9.
BACKGROUND
Systolic heart failure (SHF) and chronic obstructive pulmonary disease (COPD) are frequently associated. The purpose of our study was to explore the impact of COPD severity on symptoms and prognosis in patients with SHF.
METHODS AND RESULTS
Chronic obstructive pulmonary disease was systematically screened by spirometry in 348 patients admitted for SHF from April 2002 to December 2006. Severity of COPD was defined according to the GOLD classification. Prevalence of COPD was 37.9 %. Patients' distribution according to GOLD stages I, II, II and IV were, respectively, 51.5, 37.9, 7.6 and 3.0 %. Severity of dyspnoea increases with GOLD stage. There was a significant correlation between NYHA stage and left ventricular ejection fraction in patients without COPD (R (2) = 0.03; P = 0.01) but not in patients with COPD. Mean follow-up was of 54.9 ± 27.4 months. Mortality was 46.6 % and was highest in the COPD group (53.8 vs. 42.3 %; P = 0.049). Kaplan-Meier survival curves showed that patients with GOLD stage I had the same prognosis than patients without COPD and mortality increased from GOLD stage II to stage IV. After multivariate analysis, GOLD stage and diuretics' dose were independently associated with mortality.
CONCLUSIONS
Chronic obstructive pulmonary disease is frequent in patients with SHF and increases mortality. Since dyspnoea is poorly specific of COPD in chronic heart failure patients, COPD remains underdiagnosed thus leading to inappropriate increase of diuretics' dose. COPD should be systematically screened in patients with SHF to adapt prescription of selective β1-blockers, and diuretics' dose and reduce the exposition to risk factors.
背景
收缩性心力衰竭（SHF）和慢性阻塞性肺疾病（COPD）经常同时存在。我们的研究目的是探讨 COPD 严重程度对 SHF 患者症状和预后的影响。
方法和结果
2002 年 4 月至 2006 年 12 月，通过肺量计对 348 例因 SHF 入院的患者进行了 COPD 的系统筛查。根据 GOLD 分类定义 COPD 的严重程度。COPD 的患病率为 37.9%。根据 GOLD 分期，患者分布分别为 I 期 51.5%、II 期 37.9%、III 期 7.6%和 IV 期 3.0%。呼吸困难严重程度随 GOLD 分期增加而增加。在无 COPD 的患者中，NYHA 分期与左心室射血分数之间存在显著相关性（R²=0.03；P=0.01），但在 COPD 患者中则没有。平均随访时间为 54.9±27.4 个月。死亡率为 46.6%，COPD 组最高（53.8%比 42.3%；P=0.049）。Kaplan-Meier 生存曲线显示，GOLD 分期 I 患者的预后与无 COPD 的患者相同，而死亡率从 GOLD 分期 II 增加到 IV 期。多因素分析后，GOLD 分期和利尿剂剂量与死亡率独立相关。
结论
SHF 患者中 COPD 很常见，且增加死亡率。由于在慢性心力衰竭患者中，呼吸困难对 COPD 的特异性较差，因此 COPD 仍然诊断不足，导致利尿剂剂量不当增加。应在 SHF 患者中系统筛查 COPD，以调整选择性β1 受体阻滞剂、利尿剂剂量并减少暴露于危险因素。
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