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. 2022 Apr;118(4):680-691.
doi: 10.36660/abc.20201130.

Relationship of Lung Function and Inspiratory Strength with Exercise Capacity and Prognosis in Heart Failure

[Article in English, Portuguese]
Sergio Henrique Rodolpho Ramalho  1 , Alexandra Correa Gervazoni Balbuena de Lima  1 , Fabiola Maria Ferreira da Silva  1 , Fausto Stauffer Junqueira de Souza  1 , Lawrence Patrick Cahalin  2 , Graziella França Bernardelli Cipriano  1   3 , Gerson Cipriano Junior  1   3
Affiliations

Relationship of Lung Function and Inspiratory Strength with Exercise Capacity and Prognosis in Heart Failure

[Article in English, Portuguese]
Sergio Henrique Rodolpho Ramalho et al. Arq Bras Cardiol. 2022 Apr.

Abstract
in English, Portuguese

Background: Spirometry is underused in heart failure (HF) and the extent to which each defect associates with exercise capacity and prognosis is unclear.

Objective: To determine the distinct relationship of continuous %predicted FVC (ppFVC) and FEV1/FVC with: 1) maximal inspiratory pressure (MIP), left ventricular ejection fraction (LVEF), exercise performance; and 2) prognosis for the composite of cardiovascular death, heart transplantation or left ventricular assist device implant.

Methods: A cohort of 111 HF participants (AHA stages C/D) without diagnosed pneumopathy, spirometry, manovacuometry and maximum cardiopulmonary test. The association magnitudes were verified by linear and Cox (HR; 95% CI) regressions, age/sex adjusted. A p<0.05 was considered significant.

Results: Age was 57±12 years, 60% men, 64% in NYHA III. Every 10%-point increase in FEV1/FVC [β 7% (95% CI: 3-10)] and ppFVC [4% (2-6)] associated with ventilatory reserve (VRes), however only ppFVC associated with MIP [3.8 cmH2O (0.3-7.3)], LVEF [2.1% (0.5-3.8)] and VO2peak [0.5 mL/kg/min (0.1-1.0)], accounting for age/sex. In 2.2 years (mean), 22 events occurred, and neither FEV1/FVC (HR 1.44; 95% CI: 0.97-2.13) nor ppFVC (HR 1.13; 0.89-1.43) was significantly associated with the outcome. Only in the LVEF ≤50% subgroup (n=87, 20 events), FEV1/FVC (HR 1.50; 1.01-2.23), but not ppFVC, was associated with greater risk.

Conclusions: In chronic HF, reduced ppFVC associated with lower MIP, LVEF, VRes and VO2peak, but no distinct poorer prognosis over 2.2 years of follow-up. Distinctively, FEV1/FVC was associated only with VRes, and, in participants with LVEF ≤50%, FEV1/FVC reduction proportionally worsened prognosis. Therefore, FEV1/FVC and ppFVC add supplementary information regarding HF phenotyping.

Fundamento: A espirometria é subutilizada na insuficiência cardíaca (IC) e não está claro o grau de associação de cada defeito com a capacidade de exercício e com o prognóstico desses pacientes.

Objetivo: Determinar a relação da %CVF prevista (ppCVF) e do VEF1/CVF contínuos com: 1) pressão inspiratória máxima (PImáx), fração de ejeção do ventrículo esquerdo (FEVE) e desempenho ao exercício; e 2) prognóstico, para o desfecho composto de morte cardiovascular, transplante cardíaco ou implante de dispositivo de assistência ventricular.

Métodos: Coorte de 111 participantes com IC (estágios AHA C/D) sem pneumopatia; foram submetidos a espirometria, manovacuometria e teste cardiopulmonar máximo. As magnitudes de associação foram verificadas por regressões lineares e de Cox (HR; IC 95%), ajustadas para idade/sexo, e p <0,05 foi considerado significativo.

Resultados: Com idade média 57±12 anos, 60% eram homens, 64% em NYHAIII. A cada aumento de 10% no VEF1/CVF [β 7% (IC 95%: 3-10)] e no ppCVF [4% (2-6)], foi associado à reserva ventilatória (VRes); no entanto, apenas o ppCVF associado à PImáx [3,8cmH2O (0,3-7,3)], à fração de ejeção do ventrículo esquerdo (FEVE) [2,1% (0,5-3,8)] e ao VO2 pico [0,5mL/kg/min (0,1-1,0)], considerando idade/sexo. Em 2,2 anos (média), ocorreram 22 eventos; tanto FEV1/FVC (HR 1,44; IC 95%: 0,97-2,13) quanto ppCVF (HR 1,13; 0,89-1,43) não foram associados ao desfecho. Apenas no subgrupo FEVE ≤50% (n=87, 20 eventos), VEF1/CVF (HR 1,50; 1,01-2,23), mas não ppCVF, foi associado a risco.

Conclusão: Na IC crônica, ppCVF reduzido associou-se a menor PImáx, FEVE, VRes e VO2 pico, mas não distinguiu pior prognóstico em 2,2 anos de acompanhamento. Entretanto, VEF1/CVF associou-se apenas com VRes, e, em participantes com FEVE ≤50%, o VEF1/CVF reduzido mostrou pior prognóstico proporcional. Portanto, VEF1/CVF e ppFVC contribuem para melhor fenotipagem de pacientes com IC.

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Figures

Figura 1
Figura 1. – Associação contínua da VEF1/CVF (azul) e do percentual previsto da CVF (vermelho-claro) com VEF1, FEVE, PImáx e VO2 de usando splines cúbicos restritos. Modelos foram construídos usando splines cúbicos restritos com 3 nós. *p <0,05 em modelos adicionalmente ajustados para idade e sexo.
Figura 2
Figura 2. – Associações contínuas de VEF1/CVF (azul) e percentual previsto da CVF (vermelho) basais com o desfecho composto (morte cardiovascular, transplante cardíaco e implante de dispositivo de assistência ventricular), em tempo médio de acompanhamento de 2,2±0,7 anos (22 eventos). Modelos foram construídos para a variável primária de exposição (VEF1/CVF e percentual previsto da CVF) usando splines cúbicos restritos com 3 nós. Linear corresponde à análise de regressão de Cox. *p <0,05 em modelos adicionalmente ajustados para idade e sexo.
Figura 3
Figura 3. – Resumo visual dos achados principais: VEF1/CVF e ppCVF caracterizam de forma diferencial pacientes com insuficiência cardíaca. IC: insuficiência cardíaca; FEVE: fração de ejeção do ventrículo esquerdo; VEF1: volume expiratório forçado em 1 segundo; ppCVF: percentual previsto da capacidade vital forçada; PImáx: pressão inspiratória máxima; CV: cardiovascular; DAVE: dispositivo de assistência ventricular esquerda; HR: hazard ratio. Apesar de a ppCVF estar associada a outras variáveis funcionais além da reserva ventilatória, apenas o VEF1/CVF foi associado a prognóstico de curto prazo, particularmente para aqueles com fração de ejeção reduzida, sugerindo que cada marcador agrega diferentes informações em relação aos fenótipos da insuficiência cardíaca.
Figure 1
Figure 1. – Continuous association of FEV1/FVC (blue) and percent predicted FVC (light red) with FEV1, LVEF, MIP and VO2peak at baseline 5 using restricted cubic splines. Models were constructed using restricted cubic splines with 3 knots. *p <0.05 in models further adjusted for age and sex.
Figure 2
Figure 2. – Continuous associations of FEV1/FVC (blue) and percent predicted FVC (red) at baseline with the composite outcome (cardiovascular death, heart transplant, and left ventricular assist device implant), in a mean follow-up of 2.2±0.7 years (22 events). Models were constructed for the primary exposure variables (FEV1/FVC and percent predicted FVC) using restricted cubic splines with 3 knots. Linear corresponds to Cox regression analysis. *p <0.05 in models further adjusted for age and sex.
Figure 3
Figure 3. - Visual abstract of the main findings: FEV1/FVC and ppFVC differently characterize HF patients. HF: heart failure; LVEF: left ventricular ejection fraction; FEV1: forced expiratory volume in 1 second; ppFVC: percent predicted of forced vital capacity; MIP: maximal inspiratory pressure; CV: cardiovascular; LVAD: left ventricular assist device; HR: hazard ratio. HF: Although ppFVC was associated with other functional variables than the ventilatory reserve, only FEV1/FVC was associated with a relatively short-term prognosis, particularly for low ejection fraction, suggesting that each marker may add different information regarding HF phenotyping.
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References

    1. Neder JA, Rocha A, Berton DC, O’Donnell DE. Clinical and Physiologic Implications of Negative Cardiopulmonary Interactions in Coexisting Chronic Obstructive Pulmonary Disease-Heart Failure. Clin Chest Med. 2019;40(2):421-38. doi: 10.1016/j.ccm.2019.02.006. - PubMed
    2. Neder JA, Rocha A, Berton DC, O’Donnell DE. Clinical and Physiologic Implications of Negative Cardiopulmonary Interactions in Coexisting Chronic Obstructive Pulmonary Disease-Heart Failure. 10.1016/j.ccm.2019.02.006.Clin Chest Med. 2019;40(2):421–438. - PubMed
    1. Cundrle I Jr, Olson LJ, Johnson BD. Pulmonary Limitations in Heart Failure. Clin Chest Med. 2019;40(2):439-48. doi: 10.1016/j.ccm.2019.02.010. - PMC - PubMed
    2. Cundrle I, Jr, Olson LJ, Johnson BD. Pulmonary Limitations in Heart Failure. 10.1016/j.ccm.2019.02.010.Clin Chest Med. 2019;40(2):439–448. - PMC - PubMed
    1. Lalande S, Cross TJ, Keller-Ross ML, Morris NR, Johnson BD, Taylor BJ. Exercise Intolerance in Heart Failure: Central Role for the Pulmonary System. Exerc Sport Sci Rev. 2020;48(1):11-9. doi: 10.1249/JES.0000000000000208. - PMC - PubMed
    2. Lalande S, Cross TJ, Keller-Ross ML, Morris NR, Johnson BD, Taylor BJ. Exercise Intolerance in Heart Failure: Central Role for the Pulmonary System. 10.1249/JES.0000000000000208.Exerc Sport Sci Rev. 2020;48(1):11–19. - PMC - PubMed
    1. Canepa M, Straburzynska-Migaj E, Drozdz J, Fernandez-Vivancos C, Pinilla JMG, Nyolczas N, et al. Characteristics, Treatments and 1-year Prognosis of Hospitalized and Ambulatory Heart Failure Patients with Chronic Obstructive Pulmonary Disease in the European Society of Cardiology Heart Failure Long-Term Registry. Eur J Heart Fail. 2018;20(1):100-10. doi: 10.1002/ejhf.964. - PubMed
    2. Canepa M, Straburzynska-Migaj E, Drozdz J, Fernandez-Vivancos C, Pinilla JMG, Nyolczas N, et al. Characteristics, Treatments and 1-year Prognosis of Hospitalized and Ambulatory Heart Failure Patients with Chronic Obstructive Pulmonary Disease in the European Society of Cardiology Heart Failure Long-Term Registry. 10.1002/ejhf.964.Eur J Heart Fail. 2018;20(1):100–110. - PubMed
    1. Lawson CA, Mamas MA, Jones PW, Teece L, McCann G, Khunti K, et al. Association of Medication Intensity and Stages of Airflow Limitation With the Risk of Hospitalization or Death in Patients with Heart Failure and Chronic Obstructive Pulmonary Disease. JAMA Netw Open. 2018;1(8):e185489. doi: 10.1001/jamanetworkopen.2018.5489. - PMC - PubMed
    2. Lawson CA, Mamas MA, Jones PW, Teece L, McCann G, Khunti K, et al. Association of Medication Intensity and Stages of Airflow Limitation With the Risk of Hospitalization or Death in Patients with Heart Failure and Chronic Obstructive Pulmonary Disease. 10.1001/jamanetworkopen.2018.5489.JAMA Netw Open. 2018;1(8):e185489. - PMC - PubMed