Nakayama Mina, Konishi Masaaki, Akiyama Eiichi, Morita Yukiko, Fukutomi Yuma, Nakayama Naoki, Takamura Takeshi, Tamura Kouichi, Kimura Kazuo
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Department of Cardiology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
Heart Vessels. 2020 Jun;35(6):808-816. doi: 10.1007/s00380-020-01555-7. Epub 2020 Jan 22.
There are few reports investigating the relationship between bronchial asthma (BA) and heart failure (HF). We hypothesized BA may have impact on prognosis in patients with HF. Among 323 consecutive outpatients with HF, 191 patients without chronic obstructive pulmonary disease were analyzed. Twenty patients had BA, most of whom (80.0%) had preserved left ventricular ejection fraction (LVEF ≥ 50%). The use of β-blockers was less frequent (55.0% vs 83.0%. p = 0.01), systolic blood pressure (133 ± 22 vs 120 ± 17 mmHg, p = 0.003), and heart rate (83 ± 14 vs 74 ± 15 bpm, p = 0.02) were higher in patients with BA than those without BA. During median follow up of 24 months, 45 (23.6%) experienced primary outcome defined as a composite of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, and unexpected hospitalization due to HF. Multivariate Cox regression analysis revealed that the presence of BA was independently associated with the occurrence of primary outcome (hazard ratio 3.08, 95% CI 1.42-6.71, p = 0.004). In the subgroup analysis of patients with preserved LVEF, patients with BA exhibited worse outcomes (p = 0.03 by log-rank). Patients with HF complicated by BA, most of whom had preserved LVEF, exhibited worse outcomes than those without BA.
很少有报告研究支气管哮喘（BA）与心力衰竭（HF）之间的关系。我们推测BA可能会影响HF患者的预后。在323例连续性HF门诊患者中，对191例无慢性阻塞性肺疾病的患者进行了分析。20例患者患有BA，其中大多数（80.0%）左心室射血分数保留（LVEF≥50%）。BA患者使用β受体阻滞剂的频率较低（55.0%对83.0%，p = 0.01），收缩压（133±22对120±17 mmHg，p = 0.003）和心率（83±14对74±15次/分，p = 0.02）高于无BA的患者。在中位随访24个月期间，45例（23.6%）经历了定义为全因死亡、非致命性心肌梗死、非致命性缺血性中风和因HF意外住院的复合主要结局。多变量Cox回归分析显示，BA的存在与主要结局的发生独立相关（风险比3.08，95%CI 1.42 - 6.71，p = 0.004）。在LVEF保留患者的亚组分析中，BA患者的结局较差（对数秩检验p = 0.03）。HF合并BA的患者，其中大多数LVEF保留，其结局比无BA的患者更差。
