Prognostic Value of Resting pulmonary Function in Heart Failure

Abstract

BackgroundThe heart and lungs are intimately linked anatomically and physiologically, and, as a result, heart failure (HF) patients often develop changes in pulmonary function. This study examined the prognostic value of resting pulmonary function (PF) in HF.Methods and resultsIn all, 134 HF patients (enrolled from January 1, 1999 Through December 31, 2005; ejection fraction (EF) = 29% ± 11%; mean age = 55 ± 12 years; 65% male) were followed for 67 ± 34 months with death/transplant confirmed via the Social Security Index and Mayo Clinic registry. PF included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), diffusing capacity of the lungs for carbon monoxide (DLCO), and alveolar volume (VA). Patients were divided in tertiles according to PF with survival analysis via log-rank Mantel-Cox test with chi-square analysis. Groups for FVC included (1) >96%, (2) 96% to 81%, and (3) <81% predicted (chi-square = 18.9, P < 0.001). Bonferroni correction for multiple comparisons (BC) suggested differences between groups 1 and 3 (P < 0.001) and 2 and 3 (P = 0.008). Groups for FEV1 included (1) >94%, (2) 94% to 77%, and (3) <77% predicted (chi-square = 17.3, P <0.001). BC suggested differences between groups 1 and 3 (P <0.001). Groups for DLCO included (1) >90%, (2) 90% to 75%, and (3) <75% predicted (chi-square = 11.9, P = 0.003). BC suggested differences between groups 1 and 3 (P < 0.001). Groups for VA included (1) >97%, (2) 97% to 87%, and (3) <87% predicted (Chi-square = 8.5, P = 0.01). BC suggested differences between groups 1 and 2 (P = 0.014) and 1 and 3 (P = 0.003).ConclusionsIn a well-defined cohort of HF patients, resting measures of PF are predictive of all-cause mortality.

Pulmonary function assessment post‐left ventricular assist device implantation

“…5 Structural and functional alterations of the lungs in HF are well described 5,6 and correlate to HF severity and patient survival. 7 Therefore, it is hypothesized that the alteration in CF LVAD influences pulmonary function (PF) and is related to survival rate. However, knowledge is still lacking about the long-term effect of CF pumps on the lungs.…”

Pulmonary Function Testing and Outcomes in Subjects With Heart Failure Listed for Heart Transplantation

“…To our knowledge, this is the first study reporting the association between spirometric parameters and outcomes in this population. Studies investigating the prognostic value of spirometry in subjects with acute 25 or stable 24,26 heart failure showed that spirometric variables predict outcomes in these stage C heart failure populations. However, we did not observe a similar association in our study, in which we included subjects with stage D heart failure exclusively.…”

“…19,20 Specifically to heart failure, spirometric parameters have been demonstrated to predict incident heart failure [21][22][23] and outcomes of patients with stage C heart failure. 17,[24][25][26] However, the association of spirometric parameters with outcomes in patients with advanced (stage D) heart failure listed for heart transplantation is less clear. Patients referred for heart transplantation represent a more homogeneous population in which left ventricular function is severely impaired and congestive symptoms are common.…”

Lung diffusion capacity in advanced heart failure: relation to central haemodynamics and outcome

“…3 The co-existence of COPD and HF is often a therapeutic and diagnostic challenge in HF management, 4 and COPD in patients with HF is associated with a worse clinical status and an increased risk of cardiovascular death and hospitalizations. 12 The mechanism behind these findings, however, is unresolved. [6][7][8][9] It is well known that patients with congestive HF (CHF) have a reduction in pulmonary diffusion capacity for carbon monoxide (D LCO ), 1 and CHF is known to increase the resistance to gas transfer across the alveolarcapillary membrane.…”

“…10 Some studies have shown that a reduced diffusion capacity contributes to exercise intolerance 11 and is a predictor of mortality in HF patients. 12 The mechanism behind these findings, however, is unresolved. It is clear that cardiopulmonary interaction is an important element in HF pathophysiology.…”