FEV Predicts Cardiac Status and Outcome in Chronic Heart Failure.

Background: COPD is an established predictor of clinical outcome in patients with chronic heart failure (HF). However, little evidence is available about the predictive value of FEV in chronic HF.

Research Question: Is pulmonary function related to the progression of chronic HF?

Study Design And Methods: The MyoVasc study (ClinicalTrials.gov Identifier: NCT04064450) is a prospective cohort study of HF. Information on pulmonary and cardiac functional and structural status was obtained by body plethysmography and echocardiography. The primary study end point was worsening of HF.

Results: Overall 2,998 participants (age range, 35-84 years) with available FEV data were eligible for analysis. Linear multivariate regression analysis revealed an independent relationship of FEV (per -1 SD) with deteriorated systolic and diastolic left ventricle (LV) function as well as LV hypertrophy under adjustment of age, sex, height, cardiovascular risk factors (CVRFs), and clinical profile (LV ejection fraction: β-estimate, -1.63% [95% CI, -2.00% to -1.26%]; E/E' ratio: β-estimate, 0.82 [95% CI, 0.64-0.99]; and LV mass/height: β-estimate, 1.58 [95% CI, 1.07-2.10]; P < .001 for all). During a median time to follow-up of 2.6 years (interquartile range, 1.1-4.1 years), worsening of HF occurred in 235 individuals. In Cox regression model adjusted for age, sex, height, CVRF, and clinical profile, pulmonary function (FEV per -1 SD) was an independent predictor of worsening of HF (hazard ratio [HR], 1.44 [95% CI, 1.27-1.63]; P < .001). Additional adjustment for obstructive airway pattern and C-reactive protein mitigated, but did not substantially alter, the results underlining the robustness of the observed effect (HR, 1.39 [95% CI, 1.20-1.61]; P < .001). The predictive value of FEV was consistent across subgroups, including individuals 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).

Interpretation: FEV represents a strong candidate to improve future risk stratification and prevention strategies in individuals with chronic, stable HF.

Trial Registry: ClinicalTrials.gov; No.: NCT04064450; URL: www.clinicaltrials.gov.