Pulmonary Function Testing and Outcomes in Subjects With Heart Failure Listed for Heart Transplantation

Georgiopoulou, Vasiliki V.; Deka, Anjan; Li, Song; Niazi, Anum; Farooq, Kanwal; Kalogeropoulos, Andreas P.; Butler, Javed; Alexopoulos, Dimitrios

doi:10.4187/respcare.03709

Cited by 9 publications

(9 citation statements)

References 43 publications

(55 reference statements)

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“…However, a smaller study found no association between preoperative lung function and posttransplant survival. 14 It is important to consider that the reduction in 30-day survival observed in this study was modest compared with other risk factors, and may not be prohibitive to proceeding with transplantation. For example, the absolute difference in early mortality is much less than the risk of retransplantation or transplantation for congenital heart disease, 15 but shares similar short-term risk magnitude with other traditional risk factors such as increasing recipient age, peripheral vascular disease, and diabetes.…”

Section: -Yearmentioning

confidence: 80%

Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes

Crawford

Leary

Fraser

et al. 2020

Chest

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Section: -Yearmentioning

confidence: 80%

Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes

Crawford

Leary

Fraser

et al. 2020

Chest

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“…ILD often results in characteristics changes on PFT, including reductions in TLC, FVC and/or DLCO [11]. However, isolated or composite reductions in these metrics can be observed in numerous unrelated disease states [15][16][17][18][19], which may explain why mention of ILD was less strongly associated with pulmonology referral in these patients. Systematic screening of PFTs followed by a recommendation for chest CT or pulmonology referral when ILD features are present may facilitate a reduction in diagnostic delays observed in these patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic test interpretation and referral delay in patients with interstitial lung disease

et al. 2019

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Background: Diagnostic delays are common in patients with interstitial lung disease (ILD). A substantial percentage of patients experience a diagnostic delay in the primary care setting, but the factors underpinning this observation remain unclear. In this multi-center investigation, we assessed ILD reporting on diagnostic test interpretation and its association with subsequent pulmonology referral by a primary care physician (PCP).Methods: A retrospective cohort analysis of patients referred to the ILD programs at UC-Davis and University of Chicago by a PCP within each institution was performed. Computed tomography (CT) of the chest and abdomen and pulmonary function test (PFT) were reviewed to identify the date ILD features were first present and determine the time from diagnostic test to pulmonology referral. The association between ILD reporting on diagnostic test interpretation and pulmonology referral was assessed, as was the association between years of diagnostic delay and changes in fibrotic features on longitudinal chest CT.Results: One hundred and forty-six patients were included in the final analysis. Prior to pulmonology referral, 66% (n = 97) of patients underwent chest CT, 15% (n = 21) underwent PFT and 15% (n = 21) underwent abdominal CT. ILD features were reported on 84, 62 and 33% of chest CT, PFT and abdominal CT interpretations, respectively. ILD reporting was associated with shorter time to pulmonology referral when undergoing chest CT (1.3 vs 15.1 months, respectively; p = 0.02), but not PFT or abdominal CT. ILD reporting was associated with increased likelihood of pulmonology referral within 6 months of diagnostic test when undergoing chest CT (rate ratio 2.17, 95% CI 1.03-4.56; p = 0.04), but not PFT or abdominal CT. Each year of diagnostic delay was associated with a 1.8% increase in percent fibrosis on chest CT. Patients with documented dyspnea had shorter time to chest CT acquisition and pulmonology referral than patients with documented cough and lung crackles.Conclusions: Determinants of ILD diagnostic delays in the primary care setting include underreporting of ILD features on diagnostic testing and prolonged time to pulmonology referral even when ILD is reported. Interventions to modulate these factors may reduce ILD diagnostic delays in the primary care setting.

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“…Our study has shown that ventilatory indexes were associated with mortality in early but not in late stage of HFrEF. 35 PH was found to interact with the prognostic role of pulmonary function in long‐term outcomes in patients with HFrEF, regardless of the functional status. For patients with severe HF and concomitant PH, Ingle et al have reported the lower contribution of spirometric variables to the exercise capacity, 36 as well as insufficient power to predict long‐term outcomes.…”

Section: Discussionmentioning

confidence: 93%

Prognostic Role of Pulmonary Function in Patients With Heart Failure With Reduced Ejection Fraction

Chang

Huang

et al. 2022

JAHA

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Background Both ventilatory abnormalities and pulmonary hypertension (PH) are frequently observed in patients with heart failure with reduced ejection fraction. We aim to investigate the association between ventilatory abnormalities and PH in heart failure with reduced ejection fraction, as well as their prognostic impacts. Methods and Results A total of 440 ambulatory patients (age, 66.2±15.8 years; 77% men) with left ventricular ejection fraction ≤40% who underwent comprehensive echocardiography and spirometry were enrolled. Total lung capacity, forced vital capacity, and forced expiratory volume in the first second were obtained. Pulmonary arterial systolic pressure was estimated. PH was defined as a pulmonary arterial systolic pressure of >50 mm Hg. The primary end point was all‐cause mortality at 5 years. Patients with PH had significantly reduced total lung capacity, forced vital capacity, and forced expiratory volume in the first second. During a median follow‐up of 25.9 months, there were 111 deaths. After accounting for age, sex, body mass index, renal function, smoking, left ventricular ejection fraction, and functional capacity, total lung capacity (hazard ratio [HR] per 1 SD, 0.66; 95% CI per 1 SD, 0.46–0.96), forced vital capacity (HR per 1 SD, 0.64; 95% CI per 1 SD, 0.48–0.84), and forced expiratory volume in the first second (HR per 1 SD, 0.72; 95% CI per 1 SD, 0.53–0.98) were all significantly correlated with mortality in patients without PH. Kaplan‐Meier curve demonstrated impaired pulmonary function, defined as forced expiratory volume in the first second ≤58% of predicted or forced vital capacity ≤65% of predicted, was associated with higher mortality in patients without PH (HR, 2.85; 95% CI, 1.66–4.89), but not in patients with PH (HR, 1.05; 95% CI, 0.61–1.82). Conclusions Ventilatory abnormality was more prevalent in patients with heart failure with reduced ejection fraction with PH than those without. However, such ventilatory defects were related to long‐term survival only in patients without PH, regardless of their functional status.

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Pulmonary Function Testing and Outcomes in Subjects With Heart Failure Listed for Heart Transplantation

Cited by 9 publications

References 43 publications

Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes

Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes

Diagnostic test interpretation and referral delay in patients with interstitial lung disease

Prognostic Role of Pulmonary Function in Patients With Heart Failure With Reduced Ejection Fraction

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