Impact of chronic obstructive pulmonary disease severity on symptoms and prognosis in patients with systolic heart failure

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• 作者：Brice Arnaudis (1)
  Olivier Lairez (1) (2) (3) (4)
  Roger Escamilla (5)
  Audrey Fouilloux (1) (2) (3)
  Pauline Fournier (1)
  Benoit Monteil (1)
  Frédéric Bouisset (1)
  Jean-Fran?ois Arnal (4) (6)
  Meyer Elbaz (1) (4)
  Didier Carrié (1) (7)
  Jér?me Roncalli (1) (7)
  Atul Pathak (1) (8)
  Michel Galinier (1) (4)
  
• 关键词：Systolic heart failure ; Chronic obstructive pulmonary disease ; Dyspnoea ; GOLD stage ; Prognosis
• 刊名：Clinical Research in Cardiology
• 出版年：2012
• 出版时间：September 2012
• 年：2012
• 卷：101
• 期：9
• 页码：717-726
• 全文大小：289KB
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• 作者单位：Brice Arnaudis (1)
  Olivier Lairez (1) (2) (3) (4)
  Roger Escamilla (5)
  Audrey Fouilloux (1) (2) (3)
  Pauline Fournier (1)
  Benoit Monteil (1)
  Frédéric Bouisset (1)
  Jean-Fran?ois Arnal (4) (6)
  Meyer Elbaz (1) (4)
  Didier Carrié (1) (7)
  Jér?me Roncalli (1) (7)
  Atul Pathak (1) (8)
  Michel Galinier (1) (4)
  
  1. Department of Cardiology, University Hospital of Rangueil, 1, Avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France
  2. Cardiac Imaging Center, University Hospital of Toulouse, Toulouse, France
  3. Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France
  4. Rangueil Medical School, Toulouse, France
  5. Department of Pneumology, University Hospital of Larrey, Toulouse, France
  6. Department of Physiology, University Hospital of Rangueil, Toulouse, France
  7. Purpan Medical School, University of Toulouse, Toulouse, France
  8. Department of Clinical Pharmacology, INSERM U 1048, Université Paul Sabatier, Toulouse, France
  

文摘

Background 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. Methods and results 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?±?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. Conclusions 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 β1-blockers, and diuretics-dose and reduce the exposition to risk factors.