Bektas S, Franssen F M E, van Empel V, Uszko-Lencer N, Boyne J, Knackstedt C, Brunner-La Rocca H P
Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Neth Heart J. 2017 May;25(5):335-342. doi: 10.1007/s12471-017-0965-4.
Comorbidities are common in chronic heart failure (HF) patients, but diagnoses are often not based on objective testing. Chronic obstructive pulmonary disease (COPD) is an important comorbidity and often neglected because of shared symptoms and risk factors. Precise prevalence and consequences are not well known. Therefore, we investigated prevalence, pulmonary treatment, symptoms and quality of life (QOL) of COPD in patients with chronic HF.
205 patients with stable HF for at least 1 month, aged above 50 years, were included from our outpatient cardiology clinic, irrespective of left ventricular ejection fraction. Patients performed post-bronchodilator spirometry, a six-minute walk test (6-MWT) and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). COPD was diagnosed according to GOLD criteria. Restrictive lung function was defined as FEV/FVC ≥0.70 and FVC <80% of predicted value. The BODE and ADO index, risk scores in COPD patients, were calculated.
Almost 40% fulfilled the criteria of COPD and 7% had restrictive lung disease, the latter being excluded from further analysis. Noteworthy, 63% of the COPD patients were undiagnosed and 8% of those without COPD used inhalation therapy. Patients with COPD had more shortness of breath despite little difference in HF severity and similar other comorbidities. KCCQ was significantly worse in COPD patients. The ADO and BODE indices were significantly different.
COPD is very common in unselected HF patients. It was often not diagnosed and many patients received treatment without being diagnosed with COPD. Presence of COPD worsens symptoms and negatively effects cardiac specific QOL.
合并症在慢性心力衰竭（HF）患者中很常见，但诊断往往并非基于客观检测。慢性阻塞性肺疾病（COPD）是一种重要的合并症，常因症状和危险因素重叠而被忽视。其确切患病率及后果尚不明确。因此，我们调查了慢性HF患者中COPD的患病率、肺部治疗情况、症状及生活质量（QOL）。
从我们的门诊心脏病诊所纳入205例年龄在50岁以上、HF稳定至少1个月的患者，无论左心室射血分数如何。患者进行支气管扩张剂后肺量计检查、六分钟步行试验（6-MWT）并完成堪萨斯城心肌病问卷（KCCQ）。根据GOLD标准诊断COPD。限制性肺功能定义为FEV/FVC≥0.70且FVC<预测值的80%。计算COPD患者的BODE和ADO指数、风险评分。
近40%的患者符合COPD标准，7%患有限制性肺病，后者被排除在进一步分析之外。值得注意的是，63%的COPD患者未被诊断，8%无COPD的患者使用吸入疗法。尽管HF严重程度差异不大且其他合并症相似，但COPD患者呼吸急促更为明显。COPD患者的KCCQ明显更差。ADO和BODE指数有显著差异。
COPD在未经选择的HF患者中非常常见。它常未被诊断，许多患者在未被诊断为COPD的情况下接受了治疗。COPD的存在会加重症状并对心脏特异性QOL产生负面影响。
