Yoshihisa Akiomi, Takiguchi Mai, Shimizu Takeshi, Nakamura Yuichi, Yamauchi Hiroyuki, Iwaya Shoji, Owada Takashi, Miyata Makiko, Abe Satoshi, Sato Takamasa, Suzuki Satoshi, Oikawa Masayoshi, Kobayashi Atsushi, Yamaki Takayoshi, Sugimoto Koichi, Kunii Hiroyuki, Nakazato Kazuhiko, Suzuki Hitoshi, Saitoh Shu-ichi, Takeishi Yasuchika
Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan; Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan.
Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
J Cardiol. 2014 Oct;64(4):256-64. doi: 10.1016/j.jjcc.2014.02.003. Epub 2014 Mar 24.
Chronic obstructive pulmonary disease (COPD) often coexists with heart failure (HF), and is considered to be associated with adverse outcomes in HF patients. However, the features of cardiovascular function and the detailed all-cause mortality of HF with COPD remain unclear.
Consecutive 378 patients admitted for HF who underwent spirometry were divided into three groups: HF without COPD (non-COPD group, n=272), HF with mild COPD (GOLD I group, n=82), and HF with moderate COPD (GOLD II group, n=24). The GOLD II group, as compared to non-COPD group, had (1) higher troponin T (p=0.009); (2) greater cardio-ankle vascular index (p=0.032); and (3) similar cardiac systolic and diastolic function of the right and left ventricle. In addition, rates of cardiac (p=0.049), non-cardiac (p=0.001), and all-cause mortality (p=0.002) were higher in GOLD II group than in non-COPD and GOLD I groups. Importantly, in the Cox proportional hazard analyses, the GOLD stage II was an independent predictor of cardiac (p=0.038), non-cardiac (p=0.036), and all-cause mortality (p=0.015) in HF patients.
HF patients with coexistent moderate COPD (GOLD stage II) have greater myocardial damage, greater arterial stiffness, and higher cardiac and non-cardiac mortality.
慢性阻塞性肺疾病（COPD）常与心力衰竭（HF）并存，被认为与HF患者的不良预后相关。然而，COPD合并HF患者的心血管功能特征及详细的全因死亡率仍不清楚。
连续纳入378例因HF入院且接受肺功能检查的患者，分为三组：无COPD的HF患者（非COPD组，n = 272）、轻度COPD合并HF患者（GOLD I组，n = 82）、中度COPD合并HF患者（GOLD II组，n = 24）。与非COPD组相比，GOLD II组具有以下特点：（1）肌钙蛋白T水平更高（p = 0.009）；（2）心踝血管指数更大（p = 0.032）；（3）左右心室的心脏收缩和舒张功能相似。此外，GOLD II组的心脏死亡率（p = 0.049）、非心脏死亡率（p = 0.001）和全因死亡率（p = 0.002）均高于非COPD组和GOLD I组。重要的是，在Cox比例风险分析中，GOLD II期是HF患者心脏死亡率（p = 0.038）、非心脏死亡率（p = 0.036）和全因死亡率（p = 0.015）的独立预测因素。
合并中度COPD（GOLD II期）的HF患者心肌损伤更大、动脉僵硬度更高，心脏和非心脏死亡率更高。
