肺功能与老年期心脏功能和心力衰竭风险的关联：ARIC 研究。
Association of Pulmonary Function With Late-Life Cardiac Function and Heart Failure Risk: The ARIC Study.
机构信息
Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA.
Health Sciences and Technologies Program - University of Brasilia Brasília Brazil.
出版信息
J Am Heart Assoc. 2022 Jul 19;11(14):e023990. doi: 10.1161/JAHA.121.023990. Epub 2022 Jul 5.
Background Pulmonary and cardiac functions decline with age, but the associations of pulmonary dysfunction with cardiac function and heart failure (HF) risk in late life is not known. We aimed to determine the associations of percent predicted forced vital capacity (ppFVC) and the ratio of forced expired volume in 1 second (FEV) to forced vital capacity (FVC; FEV/FVC) with cardiac function and incident HF with preserved or reduced ejection fraction in late life. Methods and Results Among 3854 HF-free participants in the ARIC (Atherosclerosis Risk in Communities) cohort study who underwent echocardiography and spirometry at the fifth study visit (2011-2013), associations of FEV/FVC and ppFVC with echocardiographic measures, cardiac biomarkers, and risk of HF, HF with preserved ejection fraction, and HF with reduced ejection fraction were assessed. Multivariable linear and Cox regression models adjusted for demographics, body mass index, coronary disease, atrial fibrillation, hypertension, and diabetes. Mean age was 75±5 years, 40% were men, 19% were Black, and 61% were ever smokers. Mean FEV/FVC was 72±8%, and ppFVC was 98±17%. In adjusted analyses, lower FEV/FVC and ppFVC were associated with higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; both <0.001) and pulmonary artery pressure (<0.004). Lower ppFVC was also associated with higher left ventricular mass, left ventricular filling pressure, and high-sensitivity C-reactive protein (all <0.01). Lower FEV/FVC was associated with a trend toward higher risk of incident HF with preserved ejection fraction (hazard ratio [HR] per 10-point decrease, 1.31; 95% CI, 0.98-1.74; =0.07) and HF with reduced ejection fraction (HR per 10-point decrease, 1.24; 95% CI, 0.91-1.70; =0.18), but these associations did not reach statistical significance. Lower ppFVC was associated with incident HF with preserved ejection fraction (HR per 10-unit decrease, 1.21; 95% CI, 1.04-1.41; =0.013) but not with HF with reduced ejection fraction (HR per 10-unit decrease, 0.90; 95% CI, 0.76-1.07; =0.24). Conclusions Subclinical reductions in FEV/FVC and ppFVC differentially associate with cardiac function and HF risk in late life.
背景 肺部和心脏功能随年龄增长而下降，但肺部功能障碍与老年人的心脏功能和心力衰竭（HF）风险之间的关系尚不清楚。我们旨在确定预测用力肺活量百分比（ppFVC）和 1 秒用力呼气量（FEV）与用力肺活量比值（FEV/FVC）与心脏功能和射血分数保留或降低的老年人心力衰竭（HF）事件的相关性。
方法和结果 在 ARIC（社区动脉粥样硬化风险）队列研究中，3854 名 HF 患者在第五次研究访问（2011-2013 年）时接受了超声心动图和肺活量检查，评估了 FEV/FVC 和 ppFVC 与超声心动图测量值、心脏生物标志物和 HF、HF 射血分数保留和 HF 射血分数降低的相关性。多变量线性和 Cox 回归模型调整了人口统计学、体重指数、冠心病、心房颤动、高血压和糖尿病。平均年龄为 75±5 岁，40%为男性，19%为黑人，61%为曾吸烟者。平均 FEV/FVC 为 72±8%，ppFVC 为 98±17%。在调整后的分析中，较低的 FEV/FVC 和 ppFVC 与更高的 NT-proBNP（N 端脑利钠肽前体；均<0.001）和肺动脉压（<0.004）相关。较低的 ppFVC 也与更高的左心室质量、左心室充盈压和高敏 C 反应蛋白（均<0.01）相关。较低的 FEV/FVC 与射血分数保留的 HF 事件风险呈趋势相关（每降低 10 分的 HR，1.31；95%CI，0.98-1.74；=0.07）和射血分数降低的 HF（每降低 10 分的 HR，1.24；95%CI，0.91-1.70；=0.18），但这些关联没有达到统计学意义。较低的 ppFVC 与射血分数保留的 HF 事件相关（每降低 10 个单位的 HR，1.21；95%CI，1.04-1.41；=0.013），但与射血分数降低的 HF 无关（每降低 10 个单位的 HR，0.90；95%CI，0.76-1.07；=0.24）。
结论 亚临床 FEV/FVC 和 ppFVC 降低与老年人的心脏功能和 HF 风险有差异关联。
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