Prognostic value of alveolar volume in systolic heart failure: a prospective observational study

BMC Pulmonary Medicine

Roberta Poletti¹  Michele Emdin¹  Claudio Passino⁴  Ivana Pavlickova²  Matteo Bottai⁵  Simonetta Monti¹  Massimo Miniati³ 

[1] Fondazione CNR-Regione Toscana "G. Monasterio", Pisa, Italy;Istituto di Fisiologia Clinica del CNR, Pisa, Italy;Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134 Firenze, Italy;Scuola Superiore di Studi Universitari e Perfezionamento "S. Anna", Pisa, Italy;Division of Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

关键词: Survival;    Prognosis;    Alveolar volume;    Systolic heart failure;   

Others  :  1109610
DOI  :  10.1186/1471-2466-13-69

 received in 2013-01-26, accepted in 2013-11-04,  发布年份 2013

【 摘 要 】

Background

Ventilatory impairment is known to occur in patients with heart failure (HF). Alveolar volume (V_A) is measured by the dilution of an inert gas during a single breath-hold maneuver. Such measurement is sensitive to ventilatory disturbances. We conducted a prospective, observational study to establish the prognostic value of V_A in systolic HF.

Methods

We studied 260 consecutive patients who were hospitalized for systolic HF. All patients were evaluated under stable clinical conditions, before hospital discharge. Lung function studies included spirometry and determination of the lung diffusing capacity for carbon monoxide (DL_CO) by the single-breath method. We also measured the cardiothoracic ratio on frontal chest radiographs, and the circulating levels of N-terminal pro-hormone of B-type natriuretic peptide (NT-proBNP). The hazard ratio (HR) of death was estimated with Cox regression, and the percentiles of survival time with Laplace regression. For survival analysis, V_A was categorized as < 80% (n = 135), or ≥ 80% of the predicted value (n = 125).

Results

Follow-up had a median duration of 2.7 years (interquartile range, 1.1 to 4.2 years). The crude mortality rate was 27% in the whole sample, 36% in patients with V_A < 80%, and 16% in those with V_A ≥ 80%. The HR of death was 2.3-fold higher in patients with V_A < 80% than in those with V_A ≥80% (p = 0.002). After adjusting for age, New York Heart Association class III-IV, cardiothoracic ratio >0.5, NT-proBNP, persistent atrial fibrillation, DL_CO, COPD comorbidity, use of beta-blockers and angiotensin converting enzyme inhibitors, the HR decreased to 1.9 but remained statistically significant (p = 0.039). Two percent of the patients with V_A < 80% died about 0.9 years earlier than those with V_A ≥ 80% (p = 0.033). The difference in survival time at the 20th percentile was 0.8 years.

Conclusions

V_A is a significant, independent predictor of reduced survival in patients with systolic HF.

【 授权许可】

   
2013 Miniati et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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