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Impact of chronic obstructive pulmonary disease severity on symptoms and prognosis in patients with systolic heart failure

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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.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital of Rangueil, 1, Avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9, France

    Brice Arnaudis, Olivier Lairez, Audrey Fouilloux, Pauline Fournier, Benoit Monteil, Frédéric Bouisset, Meyer Elbaz, Didier Carrié, Jérôme Roncalli, Atul Pathak & Michel Galinier

  2. Cardiac Imaging Center, University Hospital of Toulouse, Toulouse, France

    Olivier Lairez & Audrey Fouilloux

  3. Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France

    Olivier Lairez & Audrey Fouilloux

  4. Rangueil Medical School, Toulouse, France

    Olivier Lairez, Jean-François Arnal, Meyer Elbaz & Michel Galinier

  5. Department of Pneumology, University Hospital of Larrey, Toulouse, France

    Roger Escamilla

  6. Department of Physiology, University Hospital of Rangueil, Toulouse, France

    Jean-François Arnal

  7. Purpan Medical School, University of Toulouse, Toulouse, France

    Didier Carrié & Jérôme Roncalli

  8. Department of Clinical Pharmacology, INSERM U 1048, Université Paul Sabatier, Toulouse, France

    Atul Pathak

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  1. Brice Arnaudis
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  2. Olivier Lairez
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  6. Benoit Monteil
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Correspondence to Olivier Lairez.

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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

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  • DOI: https://doi.org/10.1007/s00392-012-0450-4

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