Prognosis of heart failure patients with reduced and preserved ejection fraction and coexistent chronic obstructive pulmonary disease.
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.
Kwon
Beom-June
BJ
Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 130-709, Republic of Korea.
Kim
Dong-Bin
DB
Jang
Sung-Won
SW
Yoo
Ki-Dong
KD
Moon
Keun-Woong
KW
Shim
Byung Ju
BJ
Ahn
Seo-Hee
SH
Cho
Eun-Ju
EJ
Rho
Tae-Ho
TH
Kim
Jae-Hyung
JH
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