The ventilatory abnormalities and prognostic values of H₂FPEF score in dyspnoeic patients with preserved left ventricle systolic function

Abstract

Aims Heart failure with preserved ejection fraction (HFpEF) is one of the major diagnoses in dyspnoeic subjects, and H 2 FPEF score enables robust differentiation of HFpEF. Given ventilatory abnormalities prevail in subjects with HFpEF, the associations between H 2 FPEF score and pulmonary function remain to be elucidated. Methods and results Subjects who presented with exertional dyspnoea and had left ventricular ejection fraction of >50% were eligible for this study. Total lung capacity, forced expiratory volume in the 1 s, and forced vital capacity (FVC) were obtained by pulmonary function tests. Pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM) were measured by echocardiogram. Among a total of 5849 participants (65.6 ± 6.4 years, 54% men), 2453 (41.9%) had low H 2 FPEF score (0~1) and 160 (2.7%) had high H 2 FPEF score, 6~9 respectively. Subjects with high H 2 FPEF score were older and had higher proportion of restrictive and obstructive defect, more morbidities, poorer renal function, lower haemoglobin, higher LVM, E/e' ratio, and PASP. During a mean follow-up duration of 30.0 ± 20.5 months, the H 2 FPEF score was significantly associated with mortality [hazard ratio and 95% confidence intervals, 1.063(1.010-1.18)], independent of sex, haemoglobin, renal function, LVM, and comorbidities. Conclusions Either obstructive or restrictive ventilation defects prevail in subjects with high H 2 FPEF score, indicating chronic obstructive pulmonary disease (COPD) is commonly associated with HFpEF. In addition, H 2 FPEF score was correlated with long-term survival in dyspnoeic subjects with or without concomitant diseases of HFpEF and COPD.

Association between spirometry pattern, left ventricular diastolic function, and mortality

“…The INHALER registry is a longitudinal, hospital-based cohort study of 8963 ambulatory outpatients, who complained of exertional dyspnoea and underwent cardiopulmonary examinations from August 2005 to December 2012. 15,16 All the participants are required to complete echocardiography, pulmonary function test and blood test within a month. Estimated glomerular filtration (eGFR) rate was calculated by the Chinese Modification of Diet in Renal Disease equation.…”

“…Although the gold standard to assess left ventricular diastolic dysfunction is the invasive hemodynamic survey to disclose abnormal left ventricular filling pressure, echocardiographic indices, including LA dilatation, decreased tissue velocity, elevated PASP and E/e′, have been recommended as indicators of diastolic dysfunction. 15,33 While restrictive spirometry pattern has been highly prevalent in heart failure patients with either preserved or reduced LVEF, 16,34 the Jackson Heart Study has revealed the association between FVC and LA volume or PASP. 9 Cuttica et al also reported that decreased FVC positively correlated with LA dimension and left ventricular mass in CARDIA study of 3000 middle-aged subjects.…”