Pulmonary function foretells chronic heart failure outcome

Forced expiratory volume in one second (FEV1) is predictive of progression of chronic heart failure (HF), according to data from the MyoVasc study.

MyoVasc involved 2,998 (age 35–84 years) patients with chronic stable HF, all of whom had available FEV1 for analysis. The patients also underwent plethysmography and echocardiography to evaluate pulmonary and cardiac functional and structural status.

Multivariable linear regression analysis showed that FEV1 (per-1 standard deviation [SD]) had an independent association with deteriorated systolic and diastolic left ventricular (LV) function (LV ejection fraction: β-estimate, –1.63 percent, 95 percent confidence interval [CI], –2.00 to –1.26; E/E’ ratio: β-estimate, 0.82, 95 percent CI, 0.64–0.99; p<0.001). FEV1 was also linked to LV hypertrophy (LV mass/height^2.7: β-estimate, 1.58, 95 percent CI, 1.07–2.10; p<0.001).

Over a median follow up of 2.6 years, 235 patients overall showed worsening of HF. In multivariable Cox regression models, pulmonary function (FEV1 per-1SD) emerged as an independent predictor of worsening HF (hazard ratio [HR], 1.44, 95 percent CI, 1.27–1.63; p<0.001). Further adjustment for obstructive airway pattern and C-reactive protein only slightly attenuated the results, which highlighted the robustness of the observed effect (HR, 1.39, 95 percent CI, 1.20–1.61; p<0.001).

Finally, the predictive value of FEV1 was consistently seen across subgroups including nonobstructive individuals (HR, 1.55, 95 percent CI, 1.34–1.77; p<0.001) and nonsmokers (HR, 1.72, 95 percent CI, 1.39–1.96; p<0.001).

The findings indicate that FEV1 represents a strong candidate to improve future risk stratification and prevention strategies in patients with chronic HF.