Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2018 Jul 30;13(7):e0201376. doi: 10.1371/journal.pone.0201376. eCollection 2018.
Heart Failure (HF) and chronic obstructive pulmonary disease (COPD) are morbid diseases that often coexist. In patients with coexisting disease, COPD is an independent risk factor for readmission and mortality. However, spirometry is often inaccurate in those with active heart failure. Therefore, we investigated the association between the presence of emphysema on computed tomography (CT) and readmission rates in smokers admitted with heart failure (HF). The cohort included a consecutive group of smokers discharged with HF from a tertiary center between January 1, 2014 and April 1, 2014 who also had a CT of the chest for dyspnea. The primary endpoint was any readmission for HF before April 1, 2016; secondary endpoints were 30-day readmission for HF, length of stay and all-cause mortality. Over the study period, there were 225 inpatient smokers with HF who had a concurrent chest CT (155 [69%] males, age 69±11 years, ejection fraction [EF] 46±18%, 107 [48%] LVEF of < 50%). Emphysema on CT was present in 103 (46%) and these were older, had a lower BMI, more pack-years, less diabetes and an increased afterload. During a follow-up of 2.1 years, there were 110 (49%) HF readmissions and 55 (24%) deaths. When separated by emphysema on CT, any readmission, 30-day readmission, length of stay and mortality were higher among HF patients with emphysema. In multivariable regression, emphysema by CT was associated with a two-fold higher (adjusted HR 2.11, 95% CI 1.41-3.15, p < 0.001) risk of readmission and a trend toward increased mortality (adjusted HR 1.70 95% CI 0.86-3.34, p = 0.12). In conclusion, emphysema by CT is a frequent finding in smokers hospitalized with HF and is associated with adverse outcomes in HF. This under recognized group of patients with both emphysema and heart failure may benefit from improved recognition and characterization of their co-morbid disease processes and optimization of therapies for their lung disease.
心力衰竭（HF）和慢性阻塞性肺疾病（COPD）是两种常见的疾病，它们经常同时存在。在合并疾病的患者中，COPD 是再入院和死亡的独立危险因素。然而，在患有活动性心力衰竭的患者中，肺量计检查往往不准确。因此，我们研究了 CT 上肺气肿的存在与因心力衰竭（HF）入院的吸烟者再入院率之间的关系。该队列包括 2014 年 1 月 1 日至 2014 年 4 月 1 日期间在三级中心因 HF 出院的连续吸烟者，这些患者还进行了胸部 CT 检查以排除呼吸困难。主要终点是在 2016 年 4 月 1 日之前任何因 HF 再次入院；次要终点是 30 天因 HF 再次入院、住院时间和全因死亡率。在研究期间，有 225 名因 HF 住院的吸烟者同时进行了胸部 CT 检查（155 名[69%]男性，年龄 69±11 岁，射血分数[EF]46±18%，107 名[48%]左心室射血分数[LVEF]＜50%）。CT 上存在肺气肿的有 103 例（46%），这些患者年龄较大，BMI 较低，吸烟量较大，糖尿病较少，后负荷增加。在 2.1 年的随访中，有 110 例（49%）HF 再入院和 55 例（24%）死亡。当根据 CT 上的肺气肿进行分组时，有肺气肿的 HF 患者的再入院率、30 天再入院率、住院时间和死亡率均较高。在多变量回归中，CT 上的肺气肿与再入院风险增加两倍（调整后的 HR 2.11，95%CI 1.41-3.15，p<0.001）和死亡率升高趋势（调整后的 HR 1.70，95%CI 0.86-3.34，p=0.12）相关。总之，CT 上的肺气肿在因 HF 住院的吸烟者中是一种常见发现，与 HF 不良结局相关。这些同时患有肺气肿和心力衰竭且未被充分认识的患者可能受益于对其合并疾病过程的更好识别和特征描述，并优化其肺部疾病的治疗。
