慢性阻塞性肺疾病对射血分数保留的心力衰竭住院患者不良预后的预测影响 - JASPER 登记研究报告。
Prognostic impact of chronic obstructive pulmonary disease on adverse prognosis in hospitalized heart failure patients with preserved ejection fraction - A report from the JASPER registry.
机构信息
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
出版信息
J Cardiol. 2019 Jun;73(6):459-465. doi: 10.1016/j.jjcc.2019.01.005. Epub 2019 Feb 1.
BACKGROUND
The prognostic impact of chronic obstructive pulmonary disease (COPD) on heart failure (HF) with preserved ejection fraction (HFpEF) patients and its clinical characteristics have not yet been fully examined.
METHODS
The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese hospitalized HFpEF patients with left ventricular ejection fraction (LVEF) of ≥50%. Among 535 patients enrolled in the registry, 10 lacking COPD data, and seven who died during the first hospitalization, were excluded. Finally, 518 patients were enrolled in this analysis. We divided these patients into two groups: the COPD group (n=40, 7.7%) and the non-COPD group (n=478, 92.3%). This analysis had two primary endpoints: (1) all-cause death and (2) all-cause death or rehospitalization for HF.
RESULTS
The COPD group showed a higher prevalence of male sex (70.0% vs. 48.1%, p=0.008), history of prior hospitalization for HF (63.2% vs. 35.1%, p=0.001), smoking history (71.8% vs. 43.3%, p=0.001), and a higher usage of loop diuretics (70.0% vs. 50.0%, p=0.015). In the follow-up period after discharge (median 733 days), there were 82 all-cause deaths and 127 rehospitalizations for HF. In the Kaplan-Meier analysis, the COPD group showed higher all-cause death and reached the composite endpoint more often than in the non-COPD group (all-cause death, log-rank 0.035; all-cause death or rehospitalization for HF, log-rank 0.025). In the Cox proportional hazard analysis, COPD was a predictor of all-cause death (hazard ratio 1.957, 95% confidence interval 1.037-3.694, p=0.038) and the composite endpoint (hazard ratio 1.694, 95% confidence interval 1.064-2.697, p=0.026).
CONCLUSIONS
COPD is associated with adverse prognosis in hospitalized patients with HFpEF.
背景
慢性阻塞性肺疾病（COPD）对射血分数保留的心力衰竭（HFpEF）患者的预后影响及其临床特征尚未完全研究。
方法
日本射血分数保留心力衰竭综合征（JASPER）注册研究是一项全国性、观察性、前瞻性登记连续住院的 HFpEF 患者，左心室射血分数（LVEF）≥50%。在登记的 535 例患者中，排除了 10 例缺乏 COPD 数据和 7 例在首次住院期间死亡的患者。最终，518 例患者纳入本分析。我们将这些患者分为两组：COPD 组（n=40，7.7%）和非 COPD 组（n=478，92.3%）。本分析有两个主要终点：（1）全因死亡和（2）全因死亡或因 HF 再次住院。
结果
COPD 组显示男性比例较高（70.0% vs. 48.1%，p=0.008），既往因 HF 住院史（63.2% vs. 35.1%，p=0.001），吸烟史（71.8% vs. 43.3%，p=0.001）和更常使用袢利尿剂（70.0% vs. 50.0%，p=0.015）。在出院后的随访期间（中位随访时间 733 天），共有 82 例全因死亡和 127 例因 HF 再次住院。在 Kaplan-Meier 分析中，COPD 组的全因死亡和达到复合终点的比例均高于非 COPD 组（全因死亡，log-rank=0.035；全因死亡或因 HF 再次住院，log-rank=0.025）。在 Cox 比例风险分析中，COPD 是全因死亡的预测因素（风险比 1.957，95%置信区间 1.037-3.694，p=0.038）和复合终点（风险比 1.694，95%置信区间 1.064-2.697，p=0.026）。
结论
COPD 与 HFpEF 住院患者的不良预后相关。
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