Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
PLoS One. 2020 Jul 7;15(7):e0235152. doi: 10.1371/journal.pone.0235152. eCollection 2020.
The prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated.
Subjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including 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 recorded. National Death Registry was linked for the identification of mortality.
A total of 1194 patients (72.4±13.2 years, 59% men) were enrolled. PASP, E/e' and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0±12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD.
The abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD.
慢性阻塞性肺疾病（COPD）作为心力衰竭的合并症的预后价值已得到充分证实。然而，在射血分数保留的心力衰竭（HFpEF）患者中，肺功能指标的作用仍有待阐明。
HFpEF 患者接受了肺功能检查和超声心动图检查。测量了总肺容量（TLC）、残气量（RV）、用力呼气 25%至 75%肺活量时的流速（FEF25-75）、第 1 秒用力呼气量（FEV1）、用力肺活量（FVC）和肺活量（VC）。记录了超声心动图指标，包括肺动脉收缩压（PASP）、心室早期充盈流速与间隔二尖瓣环组织速度的比值（E/e'）和左心室质量（LVM）。通过国家死亡登记处确定死亡率。
共纳入 1194 例患者（72.4±13.2 岁，59%为男性）。PASP、E/e'和 LVM 与阻塞性（RV/TLC、FEV1 和 FEF25-75）或限制性（VC 和 TLC）通气指标有关。在平均 23.0±12.8 个月的随访期间，182 例患者死亡。有 COPD 的患者生存率低于没有 COPD 的患者。在没有 COPD 的患者中，VC、FVC、RV/TLC 和 FEV1 均与全因死亡率独立相关，而在 COPD 患者中，只有 FEF25-75 可以预测结局。
HFpEF 患者的肺功能异常与心脏血流动力学有关。此外，这些通气指标与长期死亡率独立相关，尤其是在没有 COPD 的患者中。
