Frequency and prognostic impact of mid-expiratory flow reduction in stable patients six months after hospitalisation for heart failure with reduced ejection fraction.
OBJECTIVE
This study investigates the prevalence and prognostic impact of central and small airways obstruction (CAO and SAO) in patients with stable heart failure (HF).


RESULTS
Spirometry was performed in 585 outpatients (mean age 65±12years, 75% male) six months after hospitalisation for acute decompensation secondary to HF with ejection fraction <40%. We assessed forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and mid-expiratory flow (MEF) at 50% of FVC. CAO was defined by FEV1/FVC <0.7. SAO was defined by FEV1/FVC ≥0.7 plus MEF <60% of predicted value. CAO and SAO were excluded in 359 patients (61% of all). MEF <60% predicted was found in 226 patients (39% of all), among those 88 with CAO (15% of all) and 138 (24% of all) with SAO. During a twelve month follow-up, 42 patients (7.2%) died. Mortality rates of patients with CAO and SAO were comparable (12.5% and 10.9%, respectively, p=0.74), and both higher than in patients without airways obstruction (4.5%, both p<0.01). In univariable Cox regression analysis, both CAO and SAO were associated with 2-fold increased all-cause mortality risk (hazard ratios [95% confidence intervals]: 2.78 [1.33-6.19], p=0.007 and 2.51 [1.24-5.08], p=0.010, respectively). Adjustment for determinants of CAO and SAO, prognostic markers of heart failure and comorbidities attenuated the association of mortality with CAO but not with SAO.


CONCLUSIONS
SAO is more common than CAO and indicates an increased mortality risk in HF. Thus, reduced MEF may be a feature of patients at risk and merits special attention in HF management.
University Hospital Würzburg and University of Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany; University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany. Electronic address: brenner_s@ukw.de.
Susanne
S
Brenner
University Hospital Würzburg and University of Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany; University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany.
Martin
M
Christa
University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany; Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany.
Dominik
D
Berliner
University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany.
Nikolas
N
Deubner
University Hospital Würzburg and University of Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany; University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany.
Georg
G
Ertl
University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany; Medical Mission Hospital, Department of Internal Medicine, Respiratory Medicine and Cardiology, Würzburg, Germany.
Matthias
M
Held
University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany.
Almuth
A
Marx
University Hospital Würzburg and University of Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany; University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany.
Christiane E
CE
Angermann
University Hospital Würzburg and University of Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany; University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany.
Stefan
S
Störk
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Frans H
FH
Rutten
University Hospital Würzburg and University of Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany; University Hospital Würzburg, Department of Internal Medicine I, Würzburg, Germany; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Gülmisal
G
Güder
D000368:Aged; D015331:Cohort Studies; D045853:Exhalation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013147:Spirometry / Q000639:trends; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors
Central airways obstruction; Mortality; Peripheral airways obstruction; Spirometry; Stable heart failure