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Background Both ventilatory abnormalities and pulmonary hypertension (PH) are frequently observed in patients with heart failure with reduced ejection fraction. We aim to investigate the association between ventilatory abnormalities and PH in heart failure with reduced ejection fraction, as well as their prognostic impacts. Methods and Results A total of 440 ambulatory patients (age, 66.2±15.8 years; 77% men) with left ventricular ejection fraction ≤40% who underwent comprehensive echocardiography and spirometry were enrolled. Total lung capacity, forced vital capacity, and forced expiratory volume in the first second were obtained. Pulmonary arterial systolic pressure was estimated. PH was defined as a pulmonary arterial systolic pressure of >50 mm Hg. The primary end point was all-cause mortality at 5 years. Patients with PH had significantly reduced total lung capacity, forced vital capacity, and forced expiratory volume in the first second. During a median follow-up of 25.9 months, there were 111 deaths. After accounting for age, sex, body mass index, renal function, smoking, left ventricular ejection fraction, and functional capacity, total lung capacity (hazard ratio [HR] per 1 SD, 0.66; 95% CI per 1 SD, 0.46-0.96), forced vital capacity (HR per 1 SD, 0.64; 95% CI per 1 SD, 0.48-0.84), and forced expiratory volume in the first second (HR per 1 SD, 0.72; 95% CI per 1 SD, 0.53-0.98) were all significantly correlated with mortality in patients without PH. Kaplan-Meier curve demonstrated impaired pulmonary function, defined as forced expiratory volume in the first second ≤58% of predicted or forced vital capacity ≤65% of predicted, was associated with higher mortality in patients without PH (HR, 2.85; 95% CI, 1.66-4.89), but not in patients with PH (HR, 1.05; 95% CI, 0.61-1.82). Conclusions Ventilatory abnormality was more prevalent in patients with heart failure with reduced ejection fraction with PH than those without. However, such ventilatory defects were related to long-term survival only in patients without PH, regardless of their functional status.

背景

在射血分数降低的心力衰竭患者中，常观察到通气异常和肺动脉高压（PH）。本研究旨在探讨射血分数降低的心力衰竭患者中通气异常与 PH 之间的相关性及其预后影响。

方法和结果

共纳入 440 名接受全面超声心动图和肺功能检查的左心室射血分数≤40%的门诊患者（年龄 66.2±15.8 岁，77%为男性）。获取肺总量、用力肺活量和 1 秒用力呼气量。估计肺动脉收缩压。PH 定义为肺动脉收缩压>50mmHg。主要终点为 5 年全因死亡率。PH 患者的肺总量、用力肺活量和 1 秒用力呼气量明显降低。中位随访 25.9 个月期间，有 111 人死亡。在考虑年龄、性别、体重指数、肾功能、吸烟、左心室射血分数和功能能力后，肺总量（每 1 SD 的危险比[HR]，0.66；95%CI 每 1 SD，0.46-0.96）、用力肺活量（每 1 SD 的 HR，0.64；95%CI 每 1 SD，0.48-0.84）和 1 秒用力呼气量（每 1 SD 的 HR，0.72；95%CI 每 1 SD，0.53-0.98）均与无 PH 患者的死亡率显著相关。Kaplan-Meier 曲线表明，在无 PH 的患者中，定义为 1 秒用力呼气量≤预测值的 58%或用力肺活量≤预测值的 65%的肺功能受损与死亡率升高相关（HR，2.85；95%CI，1.66-4.89），但在有 PH 的患者中则无此相关性（HR，1.05；95%CI，0.61-1.82）。