title: Comparison between ATS/ERS age- and gender-adjusted criteria and GOLD criteria for the detection of irreversible airway obstruction in chronic heart failure.
abstract: BACKGROUND
  Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (FEV1/FVC <70%) are extensively used for diagnosis of chronic obstructive lung disease in heart failure (HF). The American Thoracic Society (ATS)/European Respiratory Society (ERS) recommends the use of age- and gender-specific lower limit of normal (LLN) for FEV1/FVC. We compared the impact of these definitions on apparent prevalence of airway obstruction in chronic HF.
  
  
  METHODS
  Standardized pre- and post-bronchodilator spirometry was performed in HF patients. Airway obstruction was defined by ATS/ERS criteria as diagnostic standard. Additionally, airway obstruction was calculated using the GOLD criteria.
  
  
  RESULTS
  Of the 89 participants who fulfilled the ATS criteria for acceptability and reproducibility, 24.7% met ATS/ERS and 43.8% GOLD criteria for airway obstruction (Chi-square p = 0.007, McNemar <0.001). Sensitivity of GOLD criteria was 100%, specificity 74.6%, positive predictive value 56.4% and negative predictive value 100%. Among all individuals with an FEV1/FVC > LLN, 25.4% were falsely identified when using the GOLD criteria. A majority of false positives qualified for airway obstruction GOLD stage I (FEV1% ≥80%), which was significantly less often observed among true positives (76.5 vs. 31.8%; p < 0.001). Only 31.8% of patients with irreversible airway obstruction detected by the ATS/ERS criteria reported a history of COPD.
  
  
  CONCLUSIONS
  In all HF patients with persistent dyspnoea despite optimal HF treatment, spirometric testing should be performed. Application of the GOLD criteria leads to overdiagnosis of irreversible airway obstruction in patients with HF, which may result in inappropriate medical therapy and health-care decisions.
authors.affiliation: Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Steinacher
authors.forename: John T
authors.initials: JT
authors.lastname: Parissis
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strohmer
authors.forename: Jörg
authors.initials: J
authors.lastname: Eichinger
authors.forename: Dennis
authors.initials: D
authors.lastname: Rottlaender
authors.forename: Uta C
authors.initials: UC
authors.lastname: Hoppe
authors.forename: Johann
authors.initials: J
authors.lastname: Altenberger
mesh_terms: D017677:Age Distribution; D000368:Aged; D001317:Austria / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000592:standards; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D013147:Spirometry / Q000592:standards*