Huang Wei-Ming, Chang Hao-Chih, Lee Ching-Wei, Huang Chi-Jung, Yu Wen-Chung, Cheng Hao-Min, Guo Chao-Yu, Chiang Chern-En, Chen Chen-Huan, Sung Shih-Hsien
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Eur J Clin Invest. 2023 Oct;53(10):e14043. doi: 10.1111/eci.14043. Epub 2023 Jun 20.
Spirometric abnormalities have been related to incident heart failure in general population, who generally have preserved left ventricular ejection fraction (LVEF). We aimed to investigate the association between spirometric indices, cardiac functions and clinical outcomes.
Subjects presenting with exertional dyspnoea and received spirometry and echocardiography were eligible for this study. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1)/FVC ratio were measured to define the spirometry patterns: normal (FEV1/FVC ≥ 70%, FVC ≥ 80%), obstructive (FEV1/FVC < 70%, FVC ≥ 80%), restrictive pattern (FEV1/FVC ≥ 70%, FVC < 80%) and mixed (FEV1/FVC < 70%, FVC < 80%). The diastolic dysfunction index (DDi) was the counts of the indicators, including septal e' velocity <7 cm/s, septal E/e' > 15, pulmonary artery systolic pressure > 35 mmHg and left atrial dimension >40 mm.
Among a total of 8669 participants (65.8 ± 16.3 years, 56% men), 3739 (43.1%), 829 (9.6%), 3050 (35.2%) and 1051 (12.1%) had normal, obstructive, restrictive and mixed spirometry pattern, respectively. Subjects with restrictive or mixed spirometry pattern had higher DDi and worse long-term survival than those with obstructive or normal ventilation. FVC but not FEV1/FVC was predictive of 5-year mortality, independent of age, sex, renal function, LVEF, DDi, body mass index, and comorbidities (hazard ratio, 95% confidence intervals: .981, .977-.985). Furthermore, there was an inverse nonlinear relationship between FVC and DDi, suggesting the declined FVC may mediate 43% of the prognostic hazard of left ventricular diastolic dysfunction.
The restrictive spirometry pattern or the declined FVC was associated with left ventricular diastolic dysfunction, which aggravated the long-term mortality in the ambulatory dyspnoeic subjects.
肺量计检查异常与一般人群的新发心力衰竭有关，这些人群通常左心室射血分数（LVEF）保留。我们旨在研究肺量计指标、心脏功能和临床结局之间的关联。
出现劳力性呼吸困难并接受肺量计检查和超声心动图检查的受试者符合本研究条件。测量用力肺活量（FVC）和第一秒用力呼气量（FEV1）/FVC比值以定义肺量计模式：正常（FEV1/FVC≥70%，FVC≥80%）、阻塞性（FEV1/FVC<70%，FVC≥80%）、限制性模式（FEV1/FVC≥70%，FVC<80%）和混合型（FEV1/FVC<70%，FVC<80%）。舒张功能障碍指数（DDi）是指标计数，包括室间隔e'速度<7cm/s、室间隔E/e'>15、肺动脉收缩压>35mmHg和左心房内径>40mm。
在总共8669名参与者（65.8±16.3岁，56%为男性）中，分别有3739名（43.1%）、829名（9.6%）、3050名（35.2%）和1051名（12.1%）具有正常、阻塞性、限制性和混合型肺量计模式。限制性或混合型肺量计模式的受试者比阻塞性或通气正常的受试者具有更高的DDi和更差的长期生存率。FVC而非FEV1/FVC可预测5年死亡率，独立于年龄、性别、肾功能、LVEF、DDi、体重指数和合并症（风险比，95%置信区间：.981，.977-.985）。此外，FVC与DDi之间存在反向非线性关系，表明FVC下降可能介导左心室舒张功能障碍预后风险的43%。
限制性肺量计模式或FVC下降与左心室舒张功能障碍有关，这加重了门诊呼吸困难患者的长期死亡率。
