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Ittermann T, Ewert R, Habedank D, Kaczmarek S, Felix SB, Dörr M, Stubbe B, Bahls M. Proportional Internal Work-a New Parameter of Exercise Testing in Study of Health in Pomerania (SHIP). J Cardiopulm Rehabil Prev 2023; 43:460-466. [PMID: 37184451 DOI: 10.1097/hcr.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Cardiopulmonary exercise testing usually requires a maximal exhaustive effort by the patient and is time consuming. The purpose of this study was to assess whether the cost to initiate exercise termed "proportional internal work" (PIW) was related to cardiovascular disease (CVD) risk factors, ventilatory parameters, and mortality. METHODS We used data from population-based Study of Health in Pomerania. A total of 2829 (49.5% female) study participants with a median age of 52 (42-62) yr were included. Standardized questionnaires were used to assess CV risk factors. The cardiopulmonary exercise testing was performed using a modified Jones protocol. Regression models adjusted for sex and age were used to relate PIW with CVD risk factors and ventilatory parameters. The PIW was calculated by the following formula: (Oxygen uptake at rest - Oxygen uptake without load)/V˙ o2peak ) × 100. Cox regression analysis was used to relate PIW and all-cause mortality. RESULTS We identified a nonlinear association between PIW and percent predicted V˙ o2peak . Women had a 2.96 (95% CI, 2.61-3.32) greater PIW than men. With each year of age and every point in body mass index, the PWI increased by 0.04 (95% CI, 0.03-0.05) and 0.16 (95% CI, 0.12-0.20), respectively. After adjustment for age, sex, smoking, and body mass index, a 1-point greater PIW was associated with a 5% higher risk to die (HR = 1.05; 95% CI, 1.01-1.07). CONCLUSIONS The PIW is a new cardiopulmonary exercise testing parameter related to CVD risk and all-cause mortality. Future studies should assess the prognostic relevance of PIW for CVD prevention.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine (Dr Ittermann) and Department of Internal Medicine B (Drs Ewert, Habedank, Kaczmarek, Felix, Dörr, Stubbe, and Bahls), University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany (Drs Ittermann, Kaczmarek, Felix, Dörr, and Bahls); and Department of Internal Medicine, DRK Krankenhaus Berlin, Berlin, Germany (Dr Habedank)
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Cuthbert JJ, Pellicori P, Clark AL. Optimal Management of Heart Failure and Chronic Obstructive Pulmonary Disease: Clinical Challenges. Int J Gen Med 2022; 15:7961-7975. [PMID: 36317097 PMCID: PMC9617562 DOI: 10.2147/ijgm.s295467] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are common causes of breathlessness which frequently co-exist; one potentially exacerbating the other. Distinguishing between the two can be challenging due to their similar symptomatology and overlapping risk factors, but a timely and correct diagnosis is potentially lifesaving. Modern treatment for HF can substantially improve symptoms and prognosis for many patients and may have beneficial effects for patients with COPD. Conversely, while many inhaled treatments for COPD can improve symptoms and reduce exacerbations, there is conflicting evidence regarding the safety of some inhaled treatments for COPD in patients with HF. Here we explore the overlap between HF and COPD, examine the effect of one condition on the other, and address the challenges of managing patients with both conditions.
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Affiliation(s)
- Joseph J Cuthbert
- Centre for Clinical Sciences, Hull York Medical School, Kingston Upon Hull, East Riding of Yorkshire, UK,Department of Cardiology, Hull University Teaching Hospital Trust, Kingston Upon Hull, East Riding of Yorkshire, UK,Correspondence: Joseph J Cuthbert, Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston Upon Hull, HU16 5JQ, UK, Tel +44 1482 461776, Fax +44 1482 461779, Email
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Andrew L Clark
- Department of Cardiology, Hull University Teaching Hospital Trust, Kingston Upon Hull, East Riding of Yorkshire, UK
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Ferrari F. Função Pulmonar e Força Muscular Inspiratória na Insuficiência Cardíaca: Elas Podem ser Consideradas Potenciais Marcadores Prognósticos? Arq Bras Cardiol 2022; 118:692-693. [PMID: 35508045 PMCID: PMC9007001 DOI: 10.36660/abc.20211060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Heidorn MW, Steck S, Müller F, Tröbs SO, Buch G, Schulz A, Schwuchow-Thonke S, Schuch A, Strauch K, Schmidtmann I, Lackner KJ, Gori T, Münzel T, Wild PS, Prochaska JH. FEV 1 Predicts Cardiac Status and Outcome in Chronic Heart Failure. Chest 2021; 161:179-189. [PMID: 34416218 DOI: 10.1016/j.chest.2021.07.2176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COPD is an established predictor of clinical outcome in patients with chronic heart failure (HF). However, little evidence is available about the predictive value of FEV1 in chronic HF. RESEARCH QUESTION Is pulmonary function related to the progression of chronic HF? STUDY DESIGN AND METHODS The MyoVasc study (ClinicalTrials.gov Identifier: NCT04064450) is a prospective cohort study of HF. Information on pulmonary and cardiac functional and structural status was obtained by body plethysmography and echocardiography. The primary study end point was worsening of HF. RESULTS Overall 2,998 participants (age range, 35-84 years) with available FEV1 data were eligible for analysis. Linear multivariate regression analysis revealed an independent relationship of FEV1 (per -1 SD) with deteriorated systolic and diastolic left ventricle (LV) function as well as LV hypertrophy under adjustment of age, sex, height, cardiovascular risk factors (CVRFs), and clinical profile (LV ejection fraction: β-estimate, -1.63% [95% CI, -2.00% to -1.26%]; E/E' ratio: β-estimate, 0.82 [95% CI, 0.64-0.99]; and LV mass/height2.7: β-estimate, 1.58 [95% CI, 1.07-2.10]; P < .001 for all). During a median time to follow-up of 2.6 years (interquartile range, 1.1-4.1 years), worsening of HF occurred in 235 individuals. In Cox regression model adjusted for age, sex, height, CVRF, and clinical profile, pulmonary function (FEV1 per -1 SD) was an independent predictor of worsening of HF (hazard ratio [HR], 1.44 [95% CI, 1.27-1.63]; P < .001). Additional adjustment for obstructive airway pattern and C-reactive protein mitigated, but did not substantially alter, the results underlining the robustness of the observed effect (HRFEV1, 1.39 [95% CI, 1.20-1.61]; P < .001). The predictive value of FEV1 was consistent across subgroups, including individuals without obstruction (HR, 1.55 [95% CI, 1.34-1.77]; P < .001) and nonsmokers (HR, 1.72 [95% CI, 1.39-1.96]; P < .001). INTERPRETATION FEV1 represents a strong candidate to improve future risk stratification and prevention strategies in individuals with chronic, stable HF. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT04064450; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Marc W Heidorn
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Stefanie Steck
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Felix Müller
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Sven-Oliver Tröbs
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany
| | - Gregor Buch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sören Schwuchow-Thonke
- German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander Schuch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Konstantin Strauch
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tommaso Gori
- German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research, partner site Rhine Main, Mainz, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Xu S, Ye Z, Ma J, Yuan T. The impact of chronic obstructive pulmonary disease on hospitalization and mortality in patients with heart failure. Eur J Clin Invest 2021; 51:e13402. [PMID: 32916000 DOI: 10.1111/eci.13402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several studies have suggested that chronic obstructive pulmonary disease (COPD) could be predictive of the prognosis in patients with heart failure (HF), but yield conflicting findings. Therefore, we conducted a meta-analysis to examine the impact of COPD on adverse outcomes in patients with HF. METHODS We systematically searched the databases of PubMed, EMBASE, Google Scholar, Cochrane library from inception to August 2020 for the relevant studies. Adjusted risk ratios (RRs) and confidence intervals (CIs) were collected and then pooled by the Review Manager version 5.30 software with a random-effects model. RESULTS A total of 18 studies (6 post hoc analyses of trials and 12 observational studies) were included in this meta-analysis. COPD was associated with an increased risk of all-cause mortality (hospitalized HF: RR 1.43, 95% CI: 1.20-1.70; chronic HF: RR 1.24, 95% CI: 1.16-1.33), but not cardiovascular mortality, in patients with hospitalized HF or chronic HF. In addition, COPD was associated with increased risks of all-cause hospitalization (RR 1.31, 95% CI: 1.21-1.42) and HF hospitalization (RR 1.31, 95% CI: 1.21-1.42) in the chronic HF patients. CONCLUSIONS COPD comorbidity could increase the risk of all-cause mortality of HF patients. Future research should confirm the findings on hospitalization because of the limited studies included for this outcome.
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Affiliation(s)
- Shuo Xu
- Department of Respiratory and Critical Care Medicine, the Ganzhou people's Hospital, Ganzhou of Jiangxi, Ganzhou, China
| | - Zi Ye
- St Vincent Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Taiwen Yuan
- Department of Respiratory and Critical Care Medicine, the Ganzhou people's Hospital, Ganzhou of Jiangxi, Ganzhou, China
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The role of pulmonary function in patients with heart failure and preserved ejection fraction: Looking beyond chronic obstructive pulmonary disease. PLoS One 2020; 15:e0235152. [PMID: 32634145 PMCID: PMC7340281 DOI: 10.1371/journal.pone.0235152] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Background The prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated. Methods Subjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e’), and left ventricular mass (LVM), were recorded. National Death Registry was linked for the identification of mortality. Results A total of 1194 patients (72.4±13.2 years, 59% men) were enrolled. PASP, E/e’ and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0±12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD. Conclusions The abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD.
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Pellicori P, Cleland JGF, Clark AL. Chronic Obstructive Pulmonary Disease and Heart Failure: A Breathless Conspiracy. Heart Fail Clin 2020; 16:33-44. [PMID: 31735313 DOI: 10.1016/j.hfc.2019.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are both common causes of breathlessness and often conspire to confound accurate diagnosis and optimal therapy. Risk factors (such as aging, smoking, and obesity) and clinical presentation (eg, cough and breathlessness on exertion) can be very similar, but the treatment and prognostic implications are very different. This review discusses the diagnostic challenges in individuals with exertional dyspnea. Also highlighted are the prevalence, clinical relevance, and therapeutic implications of a concurrent diagnosis of COPD and HF.
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Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK.
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School, University of Hull, Kingston upon Hull HU16 5JQ, UK
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Gazizyanova VM, Bulashova OV, Hazova EV, Hasanov NR, Oslopov VN. [Clinical features and prognosis in heart failure patients with chronic obstructive pulmonary diseases]. ACTA ACUST UNITED AC 2019; 59:51-60. [PMID: 31340749 DOI: 10.18087/cardio.2674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multimorbidity is a specific characteristic of the modern patient with chronic heart failure (CHF) which significantly changes clinical course, prognosis of the syndrome, leads to socio‑economic losses and makes significant adjustments to treatment tactics. The goal is to study the clinical features and prognosis of patients with CHF in combination with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS We studied 183 HF patients, including with stable CHF, including 105 with CHF combined with COPD. The clinical phenotype was assessed by its belonging to the functional class and the severity of COPD. A 6‑minute walk test (6‑MWT), spirometry, echocardioscopy, testing on a scale assessing the clinical condition, quality of life were studied. The end points during the year were: all‑cause mortality and cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, and hospitalization rates due to acute decompensation of CHF. RESULTS The clinical phenotype of CHF combined with COPD was characterized by a high frequency of smoking, low quality of life and exercise tolerance. Respiratory dysfunction in CHF in combination with COPD was characterized by mixed disorders (68.4%), in CHF without lung disease, restrictive (25.6%). Cardiovascular mortality in comorbid pathology was 4.0%, in CHF without COPD - 4.6%; myocardial infarction was observed 1.7 times more often with lung disease than in patients with CHF only (16.8% and 10.8%); stroke was observed exclusively in comorbid pathology (8.9%). The combined endpoint (all cardiovascular events) with CHF in combination with COPD was achieved 2.3 times more often in comparison with patients with COPD only (29.7% and 15.4%). Hospitalization due to acute decompensation of CHF occurred 2 times more often with CHF in combination with COPD than without it (32.7% and 15.4%) with a tendency to increase as the left ventricular ejection fraction decreased. CONCLUSION The results of the study demonstrate that COPD contributes to the formation of the clinical phenotype of CHF from the standpoint of the mutual influence of the characteristics of the cardiovascular and respiratory systems, and also aggravates the prognosis that requires an integrated approach to the differential diagnosis and individualization of pharmacotherapy.
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Bugajski A, Frazier SK, Moser DK, Chung M, Lennie TA. Airflow limitation more than doubles the risk for hospitalization/mortality in patients with heart failure. Eur J Cardiovasc Nurs 2019; 18:245-252. [PMID: 30607982 DOI: 10.1177/1474515118822373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Comorbid chronic obstructive pulmonary disease is found in approximately one-third of patients with heart failure. Survival in patients with chronic obstructive pulmonary disease generally decreases as lung function declines. However, the association between lung function, hospitalization and survival is less clear for patients with heart failure. AIM The purpose of this study was to determine the predictive power of spirometry measures for event-free survival (combined all-cause hospitalization and/or mortality) in patients with heart failure. METHODS In this secondary analysis of data from three prospective, longitudinal studies, we selected patients with a confirmed diagnosis of heart failure who completed airflow limitation assessment using spirometry measures ( n=137): forced vital capacity, forced expiratory volume/second, and forced expiratory volume/second/forced vital capacity. Cox proportional hazards modeling was used to determine the relationship between spirometry and all-cause hospitalization/mortality with and without adjusting for demographic and clinical covariates over a four-year follow-up period. RESULTS A majority (74%) exhibited some degree of airflow limitation (forced expiratory volume/second<80% predicted value) and 26 (19%) met the spirometric criterion for chronic obstructive pulmonary disease (forced expiratory volume/second/forced vital capacity⩽0.70). Cox proportional hazards regression models compared all-cause hospitalization/mortality between those with and without airflow limitation. Patients with airflow limitation were 2.2 times more likely to be hospitalized or die compared to those without airflow limitations (hazard ratio: 2.20, 95% confidence interval 1.06-4.53, p=0.03). CONCLUSION Patients with comorbid heart failure and airflow limitation were at more than double the risk for an event. Spirometric measures may be useful to patients with heart failure, as tailored management of airflow limitation may impact event-free survival.
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Affiliation(s)
| | | | | | - Misook Chung
- 2 College of Nursing, University of Kentucky, USA
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Lawson CA, Mamas MA, Jones PW, Teece L, McCann G, Khunti K, Kadam UT. Association of Medication Intensity and Stages of Airflow Limitation With the Risk of Hospitalization or Death in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease. JAMA Netw Open 2018; 1:e185489. [PMID: 30646293 PMCID: PMC6324325 DOI: 10.1001/jamanetworkopen.2018.5489] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE In heart failure (HF), chronic obstructive pulmonary disease (COPD) increases the risk of poor outcomes, but the effect of COPD severity is unknown. This information is important for early intervention tailored to the highest-risk groups. OBJECTIVES To determine the associations between COPD medication intensity or stage of airflow limitation and the risk of hospitalization or death in patients with HF. DESIGN, SETTING, AND PARTICIPANTS This UK population-based, nested case-control study with risk-set sampling used the Clinical Practice Research Datalink linked to Hospital Episode Statistics between January 1, 2002, to January 1, 2014. Participants included patients aged 40 years and older with a new diagnosis of HF in their family practice clinical record. Data analysis was conducted from 2017 to 2018. EXPOSURES In patients with HF, those with COPD were compared with those without it. International COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD]) guidelines were used to stratify patients with COPD by 7 medication intensity levels and 4 airflow limitation severity stages using automatically recorded prescriptions and routinely requested forced expiratory volume in 1 second (FEV1) data. MAIN OUTCOMES AND MEASURES First all-cause admission or all-cause death. RESULTS There were 50 114 patients with new HF (median age, 79 years [interquartile range, 71-85 years]; 46% women) during the study period. In patients with HF, COPD (18 478 [13.8%]) was significantly associated with increased mortality (adjusted odds ratio [AOR], 1.31; 95% CI, 1.26-1.36) and hospitalization (AOR, 1.33; 95% CI, 1.26-1.39). The 3 most severe medication intensity levels showed significantly increasing mortality associations from full inhaler therapy (AOR, 1.17; 95% CI, 1.06-1.29) to oral corticosteroids (AOR, 1.69; 95% CI, 1.57-1.81) to oxygen therapy (AOR, 2.82; 95% CI, 2.42-3.28). The respective estimates for hospitalization were AORs of 1.17 (95% CI, 1.03-1.33), 1.75 (95% CI, 1.59-1.92), and 2.84 (95% CI, 1.22-3.63). Availability of spirometry data was limited but showed that increasing airflow limitation was associated with increased risk of mortality, with the following AORs: FEV1 80% or more, 1.63 (95% CI, 1.42-1.87); FEV1 50% to 79%, 1.69 (95% CI, 1.56-1.83); FEV1 30% to 49%, 2.21 (95% CI, 2.01-2.42); FEV1 less than 30%, 2.93 (95% CI, 2.49-3.43). The strength of associations between FEV1 and hospitalization risk were similar among stages ranging from FEV1 80% or more (AOR, 1.48; 95% CI, 1.31-1.68) to FEV1 less than 30% (AOR, 1.73; 95% CI, 1.40-2.12). CONCLUSIONS AND RELEVANCE In the UK HF community setting, increasing COPD severity was associated with increasing risk of mortality and hospitalization. Prescribed COPD medication intensity and airflow limitation provide the basis for targeting high-risk groups.
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Affiliation(s)
- Claire A Lawson
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keel University, Stoke-on-Trent, United Kingdom
| | - Peter W Jones
- Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Lucy Teece
- Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Gerry McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Umesh T Kadam
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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Bossone E, Arcopinto M, Iacoviello M, Triggiani V, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Sciacqua A, Perrone-Filardi P, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Monte I, Puzzo A, Ballotta A, Caliendo L, D'Assante R, Marra AM, Salzano A, Suzuki T, Cittadini A. Multiple hormonal and metabolic deficiency syndrome in chronic heart failure: rationale, design, and demographic characteristics of the T.O.S.CA. Registry. Intern Emerg Med 2018; 13:661-671. [PMID: 29619769 DOI: 10.1007/s11739-018-1844-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/24/2018] [Indexed: 12/20/2022]
Abstract
Recent evidence supports the concept that progression of chronic heart failure (CHF) depends upon an imbalance of catabolic forces over the anabolic drive. In this regard, multiple hormonal deficiency syndrome (MHDS) significantly has impacts upon CHF progression, and is associated with a worse clinical status and increased mortality. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Therapy in Heart Failure) Registry (clinicaltrial.gov = NCT02335801) tests the hypothesis that anabolic deficiencies reduce survival in a large population of mild-to-moderate CHF patients. The T.O.S.CA. Registry is a prospective multicenter observational study coordinated by "Federico II" University of Naples, and involves 19 centers situated throughout Italy. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydroepiandrosterone , and insulin are measured at baseline and every year for a patient-average follow-up of 3 years. Subjects with CHF are divided into two groups: patients with one or no anabolic deficiency, and patients with two or more anabolic deficiencies at baseline. The primary endpoint is the composite of all-cause mortality and cardiovascular hospitalization. Secondary endpoints include the composite of all-cause mortality and hospitalization, the composite of cardiovascular mortality and cardiovascular hospitalization, and change of VO2 peak. Patient enrollment started in April 2013, and was completed in July 2017. Demographics and main clinical characteristics of enrolled patients are provided in this article. Detailed cross-sectional results will be available in late 2018. The T.O.S.CA. Registry represents the most robust prospective observational trial on MHDS in the field of CHF. The study findings will advance our knowledge with regard to the intimate mechanisms of CHF progression and hopefully pave the way for future randomized clinical trials of single or multiple hormonal replacement therapies in CHF.
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Affiliation(s)
- E Bossone
- Heart Department, Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy
| | - M Arcopinto
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - M Iacoviello
- Cardiology Unit, Cardiothoracic Department, University of Bari "Aldo Moro", Bari, Italy
| | - V Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "A. Moro", Bari, Italy
| | - F Cacciatore
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - C Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - G Limongelli
- Division of Cardiology SUN, Monaldi Hospital, Azienda Ospedaliera dei Colli, Second University of Naples, Naples, Italy
| | - D Masarone
- Division of Cardiology SUN, Monaldi Hospital, Azienda Ospedaliera dei Colli, Second University of Naples, Naples, Italy
| | - F Perticone
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - A Sciacqua
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - P Perrone-Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - A Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | - M Volterrani
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - O Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - R Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - A Passantino
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy
| | - M Campo
- Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - P A Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - A De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - I Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - A Puzzo
- IRCSS. Oasi Maria SS, Troina, Italy
| | - A Ballotta
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Caliendo
- Ospedale Santa Maria della Pietà, Nola, Naples, Italy
| | | | | | - A Salzano
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - T Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - A Cittadini
- Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
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[Heart or lung? : Diagnostics and management of unclear exertional dyspnea]. Herz 2018; 43:567-582. [PMID: 30027500 DOI: 10.1007/s00059-018-4730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Exertional dyspnea is a nonspecific symptom with a variety of underlying causes. It can be challenging to differentiate a beginning cardiac disease from a pulmonary disease or from deconditioning alone. In the presence of obesity, the overall assessment is even more difficult. Rare diseases, such as pulmonary hypertension with dyspnea on exertion as the cardinal symptom are usually diagnosed late in the course of disease. The starting point of a successful evaluation is a thorough patient history. The combination of symptoms, clinical signs and findings leads to a preferred differential diagnosis. Readily available basic findings, such as physical examination, electrocardiogram (ECG), spirometry and laboratory tests help with the diagnosis. For unexplained causes, extended diagnostics such as echocardiography, blood gas analysis and finally special examinations are available. Cardiopulmonary exercise testing (CPET) and exercise echocardiography as well as right heart catheterization at rest and during exercise in the hands of experienced physicians allow an exact differentiation.
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Lee HM, Zhao Y, Liu MA, Yanez D, Carnethon M, Graham Barr R, Wong ND. Impact of lung-function measures on cardiovascular disease events in older adults with metabolic syndrome and diabetes. Clin Cardiol 2018; 41:959-965. [PMID: 29797803 DOI: 10.1002/clc.22985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/19/2018] [Accepted: 05/23/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Individuals with metabolic syndrome (MetS) and diabetes (DM) are more likely to have decreased lung function and are at greater risk of cardiovascular disease (CVD). HYPOTHESIS Lung-function measures can predict CVD events in older persons with MetS, DM, and neither condition. METHODS We followed 4114 participants age ≥ 65 years with and without MetS or DM in the Cardiovascular Health Study. Cox regression examined the association of forced vital capacity (FVC) and 1-second forced expiratory volume (FEV1 ; percent of predicted values) with incident coronary heart disease and CVD events over 12.9 years. RESULTS DM was present in 537 (13.1%) and MetS in 1277 (31.0%) participants. Comparing fourth vs first quartiles for FVC, risk of CVD events was 16% (HR: 0.84, 95% CI: 0.59-1.18), 23% (HR: 0.77, 95% CI: 0.60-0.99), and 30% (HR: 0.70, 95% CI: 0.58-0.84) lower in DM, MetS, and neither disease groups, respectively. For FEV1 , CVD risk was lower by 2% (HR: 0.98, 95% CI: 0.70-1.37), 26% (HR: 0.74, 95% CI: 0.59-0.93), and 31% (HR: 0.69, 95% CI: 0.57-0.82) in DM. Findings were strongest for predicting congestive heart failure (CHF) in all disease groups. C-statistics increased significantly with addition of FEV1 or FVC over risk factors for CVD and CHF among those with neither MetS nor DM. CONCLUSIONS FEV1 and FVC are inversely related to CVD in older adults with and without MetS, but not DM (except for CHF); however, their value in incremental risk prediction beyond standard risk factors is limited mainly to metabolically healthier persons.
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Affiliation(s)
- Hwa Mu Lee
- Division of Pulmonary and Critical Care Medicine, University of California Irvine School of Medicine, Irvine, California.,Heart Disease Prevention Program, Division of Cardiology, University of California Irvine School of Medicine, Irvine, California
| | - Yanglu Zhao
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine School of Medicine, Irvine, California.,University of California Los Angeles School of Public Health, Los Angeles, California
| | - Michael A Liu
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine School of Medicine, Irvine, California
| | - David Yanez
- Division of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Mercedes Carnethon
- Division of Preventive Medicine-Epidemiology, Northwestern University School of Medicine, Chicago, Illinois
| | - R Graham Barr
- Division of Medicine and Epidemiology, Columbia University, New York, New York
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California Irvine School of Medicine, Irvine, California
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15
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Gong TA, Hall SA. Targeting Other Modifiable Risk Factors for the Prevention of Heart Failure: Diabetes, Smoking, Obesity, and Inactivity. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Plesner LL, Dalsgaard M, Schou M, Køber L, Vestbo J, Kjøller E, Iversen K. The prognostic significance of lung function in stable heart failure outpatients. Clin Cardiol 2017; 40:1145-1151. [PMID: 28902960 DOI: 10.1002/clc.22802] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study investigated the impact on all-cause mortality of airflow limitation indicative of chronic obstructive pulmonary disease or restrictive spirometry pattern (RSP) in a stable systolic heart failure population. HYPOTHESIS Decreased lung function indicates poor survival in heart failure. METHODS Inclusion criteria: NYHA class II-IV and left ventricular ejection fraction (LVEF) < 45%. Prognosis was assessed with multivariate Cox proportional hazards models. Two criteria of obstructive airflow limitation were applied: FEV1 /FVC < 0.7 (GOLD), and FEV1 /FVC < lower limit of normality (LLN). RSP was defined as FEV1 /FVC > 0.7 and FVC<80% or FEV1 /FVC > LLN and FVC <LLN. RESULTS There where 573 patients in the cohort (85% of eligible patients in study period). Median follow-up was 4.7 years and 176 patients died (31%). Age, NYHA class, smoking, body mass index and LVEF were independent prognostic factors (p<0.01). Obstructive airflow limitation increased mortality using both criteria (HRGOLD 2.07 [95% CI 1.45-2.95] p<0.01 and HRLLN 2.00 [1.40-2.84] p<0.01) and was an independent marker when using LLN criteria (HR 1.74 [1.17-2.59] p=0.006). RSP was independently associated with mortality when defined as FVC < LLN (HR 1.54 [1.01-2.35] p=0.04) but not as FVC < 80%. Multivariate hazard ratios for a 10% decrease in predicted value of FEV1 or FVC were 1.42 (p<0.001) and 1.33 (p<0.001) in patients exhibiting airflow obstruction, and 1.36 (p=0.031) and 1.38 (p=0.041) in RSP. CONCLUSIONS Presence of obstructive airflow limitation indicative of COPD or RSP were associated with increased all-cause mortality, however only independently when using the LLN definition.
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Affiliation(s)
- Louis Lind Plesner
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Denmark
| | - Morten Dalsgaard
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jørgen Vestbo
- Centre for Respiratory Medicine and Allergy, Manchester Academic Health Science Centre, University Hospital South Manchester NHS Foundation Trust and the University of Manchester, England, United Kingdom
| | - Erik Kjøller
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Denmark
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