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Background: The prognostic importance of right ventricular (RV) dysfunction in heart failure (HF) has been suggested in patients with severe systolic heart failure. Tricuspid annular plane systolic excursion (TAPSE) is a simple echocardiographic measure of RV ejection fraction, but may be affected by co-existing chronic obstructive pulmonary disease (COPD). Aims: To examine the prognostic information from TAPSE adjusted for the potential confounding effects of co-existing cardiovascular and COPD in a large series of patients admitted for new onset or worsening HF. Methods and results: Eight hundred and seventeen patients screened for participation in a large clinical trial by trans-thoracic echocardiography, including measurement of TAPSE, were followed for a median of 4.1 years (maximum 5.5 years). Decreased TAPSE as well as presence of COPD were independently associated with adverse short-and long-term survival, hazard ratio was 0.74 (p = 0.004) for every doubling of TAPSE; and 2.4 ( p < 0.0001) for the presence of COPD. Conclusion: Decreased RV systolic function as estimated by TAPSE is associated with increased mortality in patients admitted for HF, and is independent of other risk factors in HF including left ventricular function. The co-existence of COPD is also associated with an adverse prognosis independent of the RV systolic function.

and Herlev Hospital, Herlev, Denmark). Chronic obstructive pulmonary disease in patients admitted with heart failure. J Intern Med 2008; 264: 361-369.Objective. Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in patients with heart failure (HF). The primary aims were to determine the prevalence of COPD and to test the accuracy of self-reported COPD in patients admitted with HF. Secondary aims were to study a possible relationship between right and left ventricular function and pulmonary function.Design. Prospective substudy.Setting. Systematic screening at 11 centres.Subjects. Consecutive patients (n = 532) admitted with HF requiring medical treatment with diuretics and an episode with symptoms corresponding to New York Heart Association class III-IV within a month prior to admission.Interventions. Forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) were measured by spirometry and ventricular function by echocardiography. The diagnosis of COPD and HF were made according to established criteria.Results. The prevalence of COPD was 35%. Only 43% of the patients with COPD had self-reported COPD and one-third of patients with self-reported COPD did not have COPD based on spirometry. The prevalence of COPD in patients with preserved left ventricular ejection fraction (i.e. LVEF ‡45%) was significantly higher than in patients with impaired LVEF (41% vs. 31%, P = 0.03). FEV 1 and FVC were negatively correlated with right ventricular end-diastolic diameter and tricuspid annular plane systolic excursion and FVC positively correlated with systolic gradient across the tricuspid valve.Conclusion. Chronic obstructive pulmonary disease is frequent in patients admitted with HF and self-reported COPD only identifies a minority. The prevalence of COPD was high in both patients with systolic and nonsystolic HF.

AimsThe purpose of the present study was to determine the prognostic importance for all-cause mortality of lung function variables obtained by spirometry in an unselected group of patients admitted with heart failure (HF). Methods and resultsThis was a prospective prognostic study performed as part of the EchoCardiography and Heart Outcome Study (ECHOS). This analysis included 532 patients admitted with a clinical diagnosis of HF. All patients underwent spirometry and echocardiography and the diagnosis of HF was made according to established criteria. Mean forced expiratory volume in 1 s (FEV 1 ) was 65% of the predicted value [95% confidence interval (CI) 63 -67%], mean forced vital capacity (FVC) was 71% of predicted (95% CI 69-72%), and FEV 1 /FVC was 0.72 (95% CI 0.71-0.73). FEV 1 , FVC, and FEV 1 /FVC were all significant prognostic factors for all-cause mortality in univariate analyses. In a multivariate analysis, FEV 1 had independent prognostic value (hazard ratio 0.86 per 10% change, P , 0.001) after adjusting for demographic variables, known risk factors, ejection fraction, and self-reported chronic obstructive pulmonary disease. ConclusionPulmonary function provides significant prognostic information for all-cause mortality in patients admitted with HF. Spirometry therefore seems to be worth considering for all patients admitted with HF in order to identify patients at high risk.--