Abstract 9796: The Presence of Post-bronchodilator Airflow Limitation Deteriorates Cardiac Prognosis in Patients With Chronic Heart Failure

Abstract

Background: Chronic obstructive pulmonary disease has begun to gather attention as important comorbidity in patients with cardiovascular disease. However, it is undetermined whether airflow limitation is associated with cardiac prognosis of patients with chronic heart failure (CHF). The aim of the present study was to examine whether post-bronchodilator pulmonary function can predict cardiac prognosis in patients with CHF. Methods and Results: We performed post-bronchodilator spirometry in consecutive 198 patients with CHF. Airflow limitation is assessed by the ratio of post-bronchodilator forced expiratory volume in the first 1 second and forced vital capacity (FEV 1 /FVC), and by the ratio of FEV 1 and predicted FEV 1 (%FEV 1 ). %FEV 1 but not FEV 1 /FVC was decreased with advancing New York Heart Association (NYHA) functional class. There were 45 cardiac events including 3 cardiac deaths and 42 re-hospitalizations for exacerbation of CHF during a median follow-up period of 446 days. Both FEV 1 /FVC and %FEV 1 were significantly lower in patients with cardiac events than in event-free patients (67.6 ± 12.5% v.s. 73.5 ± 9.4%, P <0.001; 66.6 ± 16.5% v.s. 80.6 ± 19.9%, P <0.0001, respectively). The receiver operating characteristic curve showed the area under the curve of FEV 1 /FVC and %FEV 1 for cardiac events were 0.667 and 0.701, respectively. Mean pulmonary arterial pressure and mean pulmonary arterial wedge pressure significantly correlated with %FEV 1 but not FEV 1 /FVC. Multivariate Cox proportional hazard analysis showed that %FEV 1 was an independent predictor of cardiac events after adjustment of possible confounders (hazard ratio per 1SD increase: 0.558; 95% confidence interval, 0.312-0.978). The patients were divided into tertiles of %FEV 1 . Kaplan-Meier analysis showed that patients in the lowest tertile had the highest event rate. Conclusion: Post-bronchodilator airflow limitation may deteriorate cardiac prognosis in patients with CHF.