Impact of chronic obstructive pulmonary disease severity on symptoms and prognosis in patients with systolic heart failure
Impact of chronic obstructive pulmonary disease severity on symptoms and prognosis in patients with systolic heart failure
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DOI：
10.1007/s00392-012-0450-4
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发表时间：
2012-09-01
影响因子：
5
通讯作者：
Galinier, Michel
中科院分区：
文献类型：
--
作者：
Arnaudis, Brice;Lairez, Olivier;Galinier, Michel
收缩性心力衰竭（SHF）和慢性阻塞性肺疾病（COPD）经常相关。本研究的目的是探讨COPD严重程度对SHF患者症状和预后的影响。通过肺活量测定法对2002年4月至2006年12月因SHF入院的348例患者进行系统筛查。根据GOLD分类定义COPD的严重程度。 COPD 患病率为 37.9%。根据 GOLD I、II、II 和 IV 期的患者分布分别为 51.5%、37.9%、7.6% 和 3.0%。呼吸困难的严重程度随着 GOLD 阶段的增加而增加。在非 COPD 患者中，NYHA 分期与左心室射血分数之间存在显着相关性（R (2) = 0.03；P = 0.01），但在 COPD 患者中则不然。平均随访时间为 54.9 +/- 27.4 个月。死亡率为 46.6%，其中 COPD 组死亡率最高（53.8% vs. 42.3%；P = 0.049）。 Kaplan-Meier 生存曲线显示，GOLD I 期患者与非 COPD 患者的预后相同，但死亡率从 GOLD II 期到 IV 期有所增加。经过多变量分析，GOLD分期和利尿剂剂量与死亡率独立相关。慢性阻塞性肺疾病在SHF患者中常见，并增加死亡率。由于慢性心力衰竭患者的呼吸困难对于COPD的特异性较差，因此COPD仍然未被充分诊断，从而导致利尿剂剂量的不当增加。应对 SHF 患者进行 COPD 系统筛查，以调整选择性 β1 受体阻滞剂和利尿剂的处方，并减少危险因素的暴露。
Systolic heart failure (SHF) and chronic obstructive pulmonary disease (COPD) are frequently associated. The purpose of our study was to explore the impact of COPD severity on symptoms and prognosis in patients with SHF.Chronic obstructive pulmonary disease was systematically screened by spirometry in 348 patients admitted for SHF from April 2002 to December 2006. Severity of COPD was defined according to the GOLD classification. Prevalence of COPD was 37.9 %. Patients' distribution according to GOLD stages I, II, II and IV were, respectively, 51.5, 37.9, 7.6 and 3.0 %. Severity of dyspnoea increases with GOLD stage. There was a significant correlation between NYHA stage and left ventricular ejection fraction in patients without COPD (R (2) = 0.03; P = 0.01) but not in patients with COPD. Mean follow-up was of 54.9 +/- A 27.4 months. Mortality was 46.6 % and was highest in the COPD group (53.8 vs. 42.3 %; P = 0.049). Kaplan-Meier survival curves showed that patients with GOLD stage I had the same prognosis than patients without COPD and mortality increased from GOLD stage II to stage IV. After multivariate analysis, GOLD stage and diuretics' dose were independently associated with mortality.Chronic obstructive pulmonary disease is frequent in patients with SHF and increases mortality. Since dyspnoea is poorly specific of COPD in chronic heart failure patients, COPD remains underdiagnosed thus leading to inappropriate increase of diuretics' dose. COPD should be systematically screened in patients with SHF to adapt prescription of selective beta 1-blockers, and diuretics' dose and reduce the exposition to risk factors.