Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
ESC Heart Fail. 2020 Aug;7(4):1872-1879. doi: 10.1002/ehf2.12754. Epub 2020 Jun 3.
Heart failure with preserved ejection fraction (HFpEF) is one of the major diagnoses in dyspnoeic subjects, and H FPEF score enables robust differentiation of HFpEF. Given ventilatory abnormalities prevail in subjects with HFpEF, the associations between H FPEF score and pulmonary function remain to be elucidated.
Subjects who presented with exertional dyspnoea and had left ventricular ejection fraction of >50% were eligible for this study. Total lung capacity, forced expiratory volume in the 1 s, and forced vital capacity (FVC) were obtained by pulmonary function tests. Pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM) were measured by echocardiogram. Among a total of 5849 participants (65.6 ± 6.4 years, 54% men), 2453 (41.9%) had low H FPEF score (0 ~ 1) and 160 (2.7%) had high H FPEF score, respectively. Subjects with high H FPEF score were older and had higher proportion of restrictive and obstructive defect, more morbidities, poorer renal function, lower haemoglobin, higher LVM, E/e' ratio, and PASP. During a mean follow-up duration of 30.0 ± 20.5 months, the H FPEF score was significantly associated with mortality [hazard ratio and 95% confidence intervals, 1.063(1.010-1.18)], independent of sex, haemoglobin, renal function, LVM, and comorbidities.
Either obstructive or restrictive ventilation defects prevail in subjects with high H FPEF score, indicating chronic obstructive pulmonary disease (COPD) is commonly associated with HFpEF. In addition, H FPEF score was correlated with long-term survival in dyspnoeic subjects with or without concomitant diseases of HFpEF and COPD.
射血分数保留的心力衰竭（HFpEF）是呼吸困难患者的主要诊断之一，HFpEF 评分能够可靠地区分 HFpEF。鉴于 HFpEF 患者中存在通气异常，HFpEF 评分与肺功能之间的关系仍有待阐明。
本研究纳入了出现运动性呼吸困难且左心室射血分数>50%的患者。通过肺功能检查获得总肺容量、1 秒用力呼气量和用力肺活量（FVC）。通过超声心动图测量肺动脉收缩压（PASP）、心室早期充盈速度与室间隔二尖瓣环组织速度的比值（E/e'）和左心室质量（LVM）。在总共 5849 名参与者（65.6±6.4 岁，54%为男性）中，2453 名（41.9%）HFpEF 评分较低（0~1），160 名（2.7%）HFpEF 评分较高。HFpEF 评分较高的患者年龄较大，限制性和阻塞性缺陷的比例较高，合并症更多，肾功能更差，血红蛋白水平更低，LVM、E/e'比值和 PASP 更高。在平均 30.0±20.5 个月的随访期间，HFpEF 评分与死亡率显著相关[风险比和 95%置信区间，1.063（1.010-1.18）]，独立于性别、血红蛋白、肾功能、LVM 和合并症。
HFpEF 评分较高的患者中存在阻塞性或限制性通气缺陷，表明慢性阻塞性肺疾病（COPD）通常与 HFpEF 相关。此外，HFpEF 评分与伴有或不伴有 HFpEF 和 COPD 合并症的呼吸困难患者的长期生存相关。
