Prognostic Role of Pulmonary Function in Patients With Heart Failure With Reduced Ejection Fraction

Hao Chih Chang, Wei Ming Huang, Wen Chung Yu, Hao Min Cheng, Chao Yu Guo, Chern En Chiang, Chen Huan Chen, Shih Hsien Sung*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish
Article numbere023422
JournalJournal of the American Heart Association
Volume11
Issue number7
DOIs
StatePublished - 5 Apr 2022

Keywords

  • heart failure with reduced ejection fraction
  • pulmonary function test
  • pulmonary hypertension
  • risk stratification

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