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The prognostic significance of lung function in stable heart failure outpatients.

The prognostic significance of lung function in stable heart failure outpatients.
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Plesner LL, Dalsgaard M, Schou M, Køber L, Vestbo J, Kjøller E, Iversen K,


Plesner LL, Dalsgaard M, Schou M, Køber L, Vestbo J, Kjøller E, Iversen K, (click to view)

Plesner LL, Dalsgaard M, Schou M, Køber L, Vestbo J, Kjøller E, Iversen K,

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Clinical cardiology 2017 09 13() doi 10.1002/clc.22802
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 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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