Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
Clin Res Cardiol. 2019 Feb;108(2):185-193. doi: 10.1007/s00392-018-1342-z. Epub 2018 Aug 8.
Differentiating heart failure from chronic obstructive pulmonary disease (COPD) in a patient presenting with breathlessness is difficult but may have implications for outcome. We investigated the prognostic impact of diagnoses of COPD and/or heart failure in consecutive patients presenting to a secondary care clinic with breathlessness.
In patients with left ventricular systolic dysfunction (LVSD) by visual estimation, N-terminal pro B-type natriuretic peptide (NTproBNP) levels and spirometry were evaluated (N = 4986). Heart failure was defined as either LVSD worse than mild (heart failure with reduced ejection fraction) or LVSD mild or better and raised NTproBNP levels (> 400 ng/L) (heart failure with normal ejection fraction). COPD was defined as forced expiratory volume in 1 s (FEV) to forced vital capacity (FVC) ratio < 0.7. The primary outcome was all-cause mortality.
1764 (35%) patients had heart failure alone, 585 (12%) had COPD alone, 1751 (35%) had heart failure and COPD, and 886 (18%) had neither. Compared to patients with neither diagnosis, those with COPD alone [hazard ratio (HR) = 1.84 95% confidence interval (CI) 1.40-2.43], heart failure alone [HR = 4.40 (95% CI 3.54-5.46)] or heart failure and COPD [HR = 5.44 (95% CI 4.39-6.75)] had a greater risk of death. COPD was not associated with increased risk of death in patients with heart failure on a multivariable analysis.
While COPD is associated with increased risk of death compared to patients with neither heart failure nor COPD, it has a negligible impact on prognosis amongst patients with heart failure.
在呼吸困难的患者中，区分心力衰竭和慢性阻塞性肺疾病（COPD）很困难，但可能对预后有影响。我们研究了在因呼吸困难就诊于二级保健诊所的连续患者中，COPD 和/或心力衰竭的诊断对预后的影响。
在通过目测估计存在左心室收缩功能障碍（LVSD）的患者中，评估了 N 端脑利钠肽前体（NTproBNP）水平和肺量测定（N=4986）。心力衰竭的定义为 LVSD 差于轻度（射血分数降低性心力衰竭）或 LVSD 轻度或更好，且 NTproBNP 水平升高（>400ng/L）（射血分数正常性心力衰竭）。COPD 的定义为 1 秒用力呼气量（FEV）与用力肺活量（FVC）的比值<0.7。主要结局为全因死亡率。
1764 例（35%）患者仅有心力衰竭，585 例（12%）仅有 COPD，1751 例（35%）既有心力衰竭又有 COPD，886 例（18%）既无心力衰竭也无 COPD。与无任何诊断的患者相比，仅患有 COPD 的患者[风险比（HR）=1.84，95%置信区间（CI）1.40-2.43]、仅患有心力衰竭的患者[HR=4.40（95%CI 3.54-5.46）]或同时患有心力衰竭和 COPD 的患者[HR=5.44（95%CI 4.39-6.75）]的死亡风险更高。多变量分析显示，在心力衰竭患者中，COPD 与死亡风险增加无关。
与既无心力衰竭又无 COPD 的患者相比，COPD 与死亡风险增加相关，但在心力衰竭患者中，COPD 对预后的影响可以忽略不计。
