Abstract 13812: Pulmonary Function Predicts Cardiac Function, Structure & Clinical Outcome in Chronic Heart Failure: Results From the Myovasc Study

Abstract

Introduction: A growing body of evidence suggests a relevance of pulmonary function in the pathophysiology of heart failure (HF). Comprehensive data on the role of forced expiratory volume in 1 second (FEV1) in the development & progression of HF is limited. Hypothesis: Given this background, we hypothesized, that (FEV1) is associated with deteriorated left ventricular (LV) functional as well as structural status, & predicts specific clinical outcome in HF. Methods: Data from the MyoVasc Study (n=3,289) were analysed. Comprehensive clinical phenotyping including body plethysmography for the evaluation of FEV1 & standardized echocardiography were performed during a five-hour investigation in a dedicated study center. Worsening of HF (comprising transition from asymptomatic to symptomatic HF, HF hospitalization, & cardiac death) was assessed during a structured follow-up with subsequent validation & adjudication of endpoints. Results: Information on FEV1 was available in 2,998 individuals (age 35-84 years; 34.1% female, mean FEV1 92.4[% predicted]). In multivariable regression analysis adjusted for age, sex, height, cardiovascular risk factors (CVRF) & clinical profile, FEV1 per-1SD was an independent predictor of reduced LV ejection fraction (β:-1.6[95%CI -2.0;-1.3]), elevated E/E’-ratio (β:0.82[0.64;0.99]), & increased LV mass/Height 2.7 (β:1.6[1.1;2.1]) (for all, P<0.001). During a median follow-up of 2.3 (interquartile range 1.1; 4.0) years, FEV1 per-1SD predicted worsening of HF (hazard ratio(HR) 1.46[1.30;1.65], P<0.001) independent of age, sex, height, CVRF & comorbidities. This finding was consistent among the single components of the primary study endpoint: FEV1 per-1SD predicted an increased risk for transition to symptomatic HF (HR 1.57[1.19;2.06]), HF hospitalization (HR 1.35[1.16;1.57]) & for cardiac death (HR 1.84[1.49;2.26]) (for all, P<0.001). FEV1 per-1SD remained an independent predictor of worsening of HF after additional adjustment for NT-proBNP (HR 1.25[1.08;1.45], P=0.002). Conclusion: Impaired FEV1 is directly linked to the pathophysiology of HF & represents a strong & independent predictor of HF outcome highlighting its potential value to advance risk prediction in HF.