title: Prognosis of heart failure patients with reduced and preserved ejection fraction and coexistent chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  The long-term prognosis of patients with heart failure with preserved left ventricular ejection fraction (HFPEF) and coexistent chronic obstructive pulmonary disease (COPD) has not been previously investigated. The primary aim of this study was to determine whether the long-term prognosis of HFPEF patients with COPD differs from that of heart failure patients with reduced left ventricular ejection fraction (HFREF) and COPD. The secondary aim was to identify independent predictors of event-free survival in patients with HF and COPD.
  
  
  RESULTS
  We investigated 184 patients with coexistent HF and COPD. Heart failure with preserved left ventricular ejection fraction was present in 98 cases (53%) and HFREF in the remaining 86 cases (47%). Mean follow-up time was 731±369 days. Cardiovascular/pulmonary hospitalization or mortality occurred in 71 patients (39%). No significant difference was observed between the two study groups in terms of event-free survival (P=0.457), but event-free survival was found to be independently associated with New York Heart Association (NYHA) class [III vs. I, hazard ratio (HR) 2.92, 95% confidence interval (CI) 1.09-7.82], Global initiative for chronic Obstructive Lung Disease (GOLD) stage (III vs. I, HR 3.20, 95% CI 1.33-7.68), systemic hypertension (SHT; HR 2.99, 95% CI 1.41-6.33), and pulmonary hypertension (PH; HR 4.35, 95% CI 1.95-9.68).
  
  
  CONCLUSIONS
  In HF patients with coexisting COPD, cardiovascular and pulmonary event-free survival of HFPEF was found to be similar to that of HFREF over 3 years follow-up. Furthermore, severe NYHA class, severe GOLD stage, SHT, and PH were found to be independent predictors of event-free survival.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 130-709, Republic of Korea.
authors.forename: Beom-June
authors.initials: BJ
authors.lastname: Kwon
authors.forename: Dong-Bin
authors.initials: DB
authors.lastname: Kim
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jang
authors.forename: Ki-Dong
authors.initials: KD
authors.lastname: Yoo
authors.forename: Keun-Woong
authors.initials: KW
authors.lastname: Moon
authors.forename: Byung Ju
authors.initials: BJ
authors.lastname: Shim
authors.forename: Seo-Hee
authors.initials: SH
authors.lastname: Ahn
authors.forename: Eun-Ju
authors.initials: EJ
authors.lastname: Cho
authors.forename: Tae-Ho
authors.initials: TH
authors.lastname: Rho
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005541:Forced Expiratory Volume; D006305:Health Status Indicators; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007723:Korea / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left