Abstract
Background
Systolic heart failure (SHF) and chronic obstructive pulmonary disease (COPD) are frequently associated. The purpose of our study was to explore the impact of COPD severity on symptoms and prognosis in patients with SHF.
Methods and results
Chronic obstructive pulmonary disease was systematically screened by spirometry in 348 patients admitted for SHF from April 2002 to December 2006. Severity of COPD was defined according to the GOLD classification. Prevalence of COPD was 37.9 %. Patients’ distribution according to GOLD stages I, II, II and IV were, respectively, 51.5, 37.9, 7.6 and 3.0 %. Severity of dyspnoea increases with GOLD stage. There was a significant correlation between NYHA stage and left ventricular ejection fraction in patients without COPD (R 2 = 0.03; P = 0.01) but not in patients with COPD. Mean follow-up was of 54.9 ± 27.4 months. Mortality was 46.6 % and was highest in the COPD group (53.8 vs. 42.3 %; P = 0.049). Kaplan–Meier survival curves showed that patients with GOLD stage I had the same prognosis than patients without COPD and mortality increased from GOLD stage II to stage IV. After multivariate analysis, GOLD stage and diuretics’ dose were independently associated with mortality.
Conclusions
Chronic obstructive pulmonary disease is frequent in patients with SHF and increases mortality. Since dyspnoea is poorly specific of COPD in chronic heart failure patients, COPD remains underdiagnosed thus leading to inappropriate increase of diuretics’ dose. COPD should be systematically screened in patients with SHF to adapt prescription of selective β1-blockers, and diuretics’ dose and reduce the exposition to risk factors.
Similar content being viewed by others
References
Rutten FH, Cramer MJ, Lammers JW, Grobbee DE, Hoes AW (2006) Heart failure and chronic obstructive pulmonary disease: an ignored combination? Eur J Heart Fail 8(7):706–711
Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ (2009) Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 11(2):130–139
Mannino DM, Brown C, Giovino GA (1997) Obstructive lung disease deaths in the United States from 1979 through 1993. An analysis using multiple-cause mortality data. Am J Respir Crit Care Med 156(3 Pt 1):814–818
Levy D, Kenchaiah S, Larson MG, Benjamin EJ, Kupka MJ, Ho KK, Murabito JM, Vasan RS (2002) Long-term trends in the incidence of and survival with heart failure. N Engl J Med 347(18):1397–1402
Finkelstein J, Cha E, Scharf SM (2009) Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis 4:337–349
Boudestein LC, Rutten FH, Cramer MJ, Lammers JW, Hoes AW (2009) The impact of concurrent heart failure on prognosis in patients with chronic obstructive pulmonary disease. Eur J Heart Fail 11(12):1182–1188
Hawkins NM, Petrie MC, Macdonald MR, Jhund PS, Fabbri LM, Wikstrand J, McMurray JJ (2011) Heart failure and chronic obstructive pulmonary disease the quandary of Beta-blockers and Beta-agonists. J Am Coll Cardiol 57(21):2127–2138
Iversen KK, Kjaergaard J, Akkan D, Kober L, Torp-Pedersen C, Hassager C, Vestbo J, Kjoller E (2010) The prognostic importance of lung function in patients admitted with heart failure. Eur J Heart Fail 12(7):685–691
Kwon BJ, Kim DB, Jang SW, Yoo KD, Moon KW, Shim BJ, Ahn SH, Cho EJ, Rho TH, Kim JH (2010) Prognosis of heart failure patients with reduced and preserved ejection fraction and coexistent chronic obstructive pulmonary disease. Eur J Heart Fail 12(12):1339–1344
Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29(19):2388–2442
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176(6):532–555
Iversen KK, Kjaergaard J, Akkan D, Kober L, Torp-Pedersen C, Hassager C, Vestbo J, Kjoller E (2008) Chronic obstructive pulmonary disease in patients admitted with heart failure. J Intern Med 264(4):361–369
Rusinaru D, Saaidi I, Godard S, Mahjoub H, Battle C, Tribouilloy C (2008) Impact of chronic obstructive pulmonary disease on long-term outcome of patients hospitalized for heart failure. Am J Cardiol 101(3):353–358
Macchia A, Monte S, Romero M, D’Ettorre A, Tognoni G (2007) The prognostic influence of chronic obstructive pulmonary disease in patients hospitalised for chronic heart failure. Eur J Heart Fail 9(9):942–948
Puri S, Dutka DP, Baker BL, Hughes JM, Cleland JG (1999) Acute saline infusion reduces alveolar-capillary membrane conductance and increases airflow obstruction in patients with left ventricular dysfunction. Circulation 99(9):1190–1196
Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Plata V, Cabral HJ (2004) The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 350(10):1005–1012
Gorelik O, Almoznino-Sarafian D, Shteinshnaider M, Alon I, Tzur I, Sokolsky I, Efrati S, Babakin Z, Modai D, Cohen N (2009) Clinical variables affecting survival in patients with decompensated diastolic versus systolic heart failure. Clin Res Cardiol 98(4):224–232. doi:10.1007/s00392-009-0746-1
Edelmann F, Stahrenberg R, Gelbrich G, Durstewitz K, Angermann CE, Dungen HD, Scheffold T, Zugck C, Maisch B, Regitz-Zagrosek V, Hasenfuss G, Pieske BM, Wachter R (2011) Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction. Clin Res Cardiol 100(9):755–764. doi:10.1007/s00392-011-0305-4
Mascarenhas J, Lourenco P, Lopes R, Azevedo A, Bettencourt P (2008) Chronic obstructive pulmonary disease in heart failure. Prevalence, therapeutic and prognostic implications. Am Heart J 155(3):521–525
Salpeter S, Ormiston T, Salpeter E (2005) Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 19(4):CD003566
Dransfield MT, Rowe SM, Johnson JE, Bailey WC, Gerald LB (2008) Use of beta blockers and the risk of death in hospitalised patients with acute exacerbations of COPD. Thorax 63(4):301–305
Macie C, Wooldrage K, Manfreda J, Anthonisen N (2008) Cardiovascular morbidity and the use of inhaled bronchodilators. Int J Chron Obstruct Pulmon Dis 3(1):163–169
Au DH, Udris EM, Curtis JR, McDonell MB, Fihn SD (2004) Association between chronic heart failure and inhaled β-2-adrenoceptor agonists. Am Heart J 148(5):915–920
Au DH, Curtis JR, Every NR, McDonell MB, Fihn SD (2002) Association between inhaled beta-agonists and the risk of unstable angina and myocardial infarction. Chest 121(3):846–851
Lemaitre RN, Siscovick DS, Psaty BM, Pearce RM, Raghunathan TE, Whitsel EA, Weinmann SA, Anderson GD, Lin D (2002) Inhaled β-2 adrenergic receptor agonists and primary cardiac arrest. Am J Med 113(9):711–716
Hawkins NM, MacDonald MR, Petrie MC, Chalmers GW, Carter R, Dunn FG, McMurray JJ (2009) Bisoprolol in patients with heart failure and moderate to severe chronic obstructive pulmonary disease: a randomized controlled trial. Eur J Heart Fail 11(7):684–690
Au DH, Udris EM, Fan VS, Curtis JR, McDonell MB, Fihn SD (2003) Risk of mortality and heart failure exacerbations associated with inhaled beta-adrenoceptor agonists among patients with known left ventricular systolic dysfunction. Chest 123(6):1964–1969
Bermingham M, O’Callaghan E, Dawkins I, Miwa S, Samsudin S, McDonald K, Ledwidge M (2011) Are β-2-agonists responsible for increased mortality in heart failure? Eur J Heart Fail 13(8):885–891
Brooks TW, Creekmore FM, Young DC, Asche CV, Oberg B, Samuelson WM (2007) Rates of hospitalizations and emergency department visits in patients with asthma and chronic obstructive pulmonary disease taking beta-blockers. Pharmacotherapy 27(5):684–690
Jabbour A, Macdonald PS, Keogh AM, Kotlyar E, Mellemkjaer S, Coleman CF, Elsik M, Krum H, Hayward CS (2010) Differences between beta-blockers in patients with chronic heart failure and chronic obstructive pulmonary disease: a randomized crossover trial. J Am Coll Cardiol 55(17):1780–1787
Mogelvang R, Goetze JP, Schnohr P, Lange P, Sogaard P, Rehfeld JF, Jensen JS (2007) Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnea by plasma pro-B-type natriuretic peptide. J Am Coll Cardiol 50(17):1694–1701
Franke J, Frankenstein L, Schellberg D, Bajrovic A, Wolter JS, Ehlermann P, Doesch AO, Nelles M, Katus HA, Zugck C (2011) Is there an additional benefit of serial NT-proBNP measurements in patients with stable chronic heart failure receiving individually optimized therapy? Clin Res Cardiol 100(12):1059–1067. doi:10.1007/s00392-011-0340-1
Zugck C, Franke J, Gelbrich G, Frankenstein L, Scheffold T, Pankuweit S, Duengen HD, Regitz-Zagrosek V, Pieske B, Neumann T, Rauchhaus M, Angermann CE, Katus HA, Ertl GE, Stork S (2011) Implementation of pharmacotherapy guidelines in heart failure: experience from the German Competence Network Heart Failure. Clin Res Cardiol. doi:10.1007/s00392-011-0388-y
Andreas S, Anker SD, Scanlon PD, Somers VK (2005) Neurohumoral activation as a link to systemic manifestations of chronic lung disease. Chest 128(5):3618–3624
Sakamaki F, Satoh T, Nagaya N, Kyotani S, Nakanishi N, Ishida Y (1999) Abnormality of left ventricular sympathetic nervous function assessed by (123)I-metaiodobenzylguanidine imaging in patients with COPD. Chest 116(6):1575–1581
Hawkins NM, Huang Z, Pieper KS, Solomon SD, Kober L, Velazquez EJ, Swedberg K, Pfeffer MA, McMurray JJ, Maggioni AP (2009) Chronic obstructive pulmonary disease is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Eur J Heart Fail 11(3):292–298
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arnaudis, B., Lairez, O., Escamilla, R. et al. Impact of chronic obstructive pulmonary disease severity on symptoms and prognosis in patients with systolic heart failure. Clin Res Cardiol 101, 717–726 (2012). https://doi.org/10.1007/s00392-012-0450-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-012-0450-4