Abstract 11030: Severity of Airflow Limitation Predicts Exercise Capacity and Adverse Clinical Outcomes in Chronic Heart Failure
Background: Airflow limitation leads to exercise intolerance and poor prognosis in chronic obstructive pulmonary disease (COPD). In chronic heart failure (CHF), COPD is common comorbidity. However, the impact of COPD has not been fully recognized in CHF. We aimed to evaluate the clinical characteristics and outcomes of CHF patients accompanied by airflow limitation.
Methods and Results: Consecutive 632 patients with CHF who underwent spirometry and cardiopulmonary exercise testing (CPX) were enrolled. Out of 632 CHF patients, 99 patients were diagnosed with COPD (ratio of forced expiratory volume in first / forced vital capacity [FEV1.0/FVC] <0.7) by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The patients were followed up to register cardiac events including cardiac death and re-hospitalization due to worsening heart failure. There were 244 events during follow-up period (947± 512 days). Patients with COPD were older than those without COPD. Patients with COPD had lower body mass index (BMI), lower estimated glomerular filtration rate (eGFR), lower hemoglobin concentration, smaller left ventricular volume, lower peak VO2 and minute ventilation/carbon dioxide production slope (VE/VCO2 slope) than those without COPD. Patients with COPD were more frequently associated with cardiac events than those without COPD (49.5% vs 36.6%, P=0.02). In multiple linear regression analysis, FEV1.0/FVC, hemoglobin concentration, left ventricular ejection fraction and VE/VCO2 slope were independent parameters to predict peak VO2 (P<0.01, respectively). After adjusting for 20 variables assodiated with causing adverse cardiac event, FEV1.0/FVC was an independent factor to predict cardiac events in Cox proportional hazard regression analysis (adjusted hazard ratio 1.018, 95% confidence interval 1.004-1.033, P=0.011).
Conclusions: Severity of airflow limitation was an important factor to determine exercise capacity and to predict adverse cardiac events in patients with CHF.
- © 2013 by American Heart Association, Inc.