Pulmonary function may improve risk stratification, prevention strategies for heart failure

FEV₁ may play an important role in improving the risk stratification and prevention strategies among individuals with heart failure, researchers reported in Chest.

Researchers analyzed data from the prospective cohort MyoVasc study, which included 2,998 participants (mean age, 64.2 years; 36.8% women) with heart failure (HF) and available FEV₁ data. Researchers collected information on pulmonary and cardiac functional and structural status using body plethysmography and echocardiography.

“Comprehensive data on FEV₁ as [a] biomarker of disease progression in HF currently are scarce because previous studies were limited in sample size, were registry-based, were lacking examination of the relationship between FEV₁ and echocardiographic measures of cardiac function and structure or did not investigate HF-specific clinical outcomes across the full spectrum of HF,” Marc W. Heidorn, MD, from the Center for Thrombosis and Hemostasis and the University Medical Center of Johannes Gutenberg University Mainz and the German Center for Cardiovascular Research, Germany, and colleagues wrote.

The primary outcome was worsening HF.

Researchers observed worsening HF in 235 individuals during a median follow-up of 2.6 years. The rate of HF worsening was about 3.5-fold higher among individuals in the lowest FEV₁ quartile (< 80.3% predicted) compared with the highest quartile of an FEV₁ ( 105% percent predicted; P < .001).

The researchers reported an independent relationship between FEV1 and deteriorated systolic and diastolic left ventricle function and left ventricular hypertrophy after adjusting for age, sex, height, cardiovascular risk factors and clinical profile in a linear multivariate regression analysis (P < .001 for all).

Pulmonary function measured by FEV₁ was an independent risk factor for worsening HF (HR = 1.44; 95% CI, 1.27-1.63; P < .001).

After adjusting for obstructive airway pattern and C-reactive protein, these results did not substantially differ (HR = 1.39 ;95% CI, 1.2-1.61; P < .001), according to the researchers.

FEV₁ predictive value remained consistent across all subgroups, including those without obstruction (HR = 1.55; 95% CI, 1.34-1.77; P < .001) and nonsmokers (HR = 1.72; 95% CI, 1.39-1.96; P < .001).

The researchers reported a trend toward a larger effect size for FEV₁ in those with HF with preserved ejection fraction (HR = 1.56; 95% CI, 1.22-1.52) compared with HF with reduced ejection fraction (HR = 1.21; 95% CI, 0.96-1.52).

“The present study demonstrated a high clinical relevance of reduced pulmonary function for individuals with chronic, stable HF. Because deteriorated FEV₁ translated into impaired [left ventricular] function as well as [left ventricular hypertrophy], its role for the development and progression of HF merits attention in both mechanistic and prognostic studies. Given the strong and robust evidence in the present study, FEV₁ represents a strong candidate to improve future risk stratification and prevention strategies in individuals with chronic, stable HF,” the researchers wrote.