Obstructive and restrictive spirometry patterns associated with late-life heart failure risk: JAHA

USA: Among patients with no pre-existing heart failure or pulmonary disease, both obstructive and restrictive spirometry patterns are associated with elevated pulmonary pressures, higher NT-proBNP levels, and an overall increased risk of incident heart failure, particularly in late life, reports ARIC study. 

The findings, published in the Journal of the American Heart Association highlight the importance of pulmonary dysfunction with cardiac dysfunction interactions and the differential associations of obstructive and restrictive spirometric deficits with the risk of HF and particularly HFpEF in late life. 

Subclinical impairments in lung function detected by spirometry are associated with alterations in cardiac structure and function and cardiovascular events in early adulthood and midlife. Spirometry measures the rate at which the lung changes volume during forced breathing maneuvers. Previous studies showed that subclinical lung function impairment is related to a measurable reduction of left ventricular filling and cardiac output in the general population. Pulmonary and cardiac functions decline with age, but the extent to which subclinical lung‐heart interactions previously described in early life and midlife extend into late life is not known.

Sergio H., University of Brasilia, Brazil, and colleagues conducted a study to determine the associations of percent predicted forced vital capacity (ppFVC) and the ratio of forced expired volume in 1 second (FEV1) to forced vital capacity (FVC; FEV1/FVC) with cardiac function and incident HF with preserved or reduced ejection fraction in late life.

Researchers enrolled 3854 participants (Mean age 75±5 years), with no pre-existing heart failure for the present study, who underwent echocardiography and spirometry at the fifth study visit. Associations of FEV1/FVC and ppFVC with echocardiographic measures, cardiac biomarkers, and risk of HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction(HFrEF) were assessed.

Key findings of the study,

• Lower FEV1/FVC and ppFVC were associated with higher NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; both P<0.001) and pulmonary artery pressure.

• Lower ppFVC was associated with higher left ventricular mass, left ventricular filling pressure, and high‐sensitivity C‐reactive protein. 

• Lower FEV1/FVC was associated with a trend toward a higher risk of incident HFpEF (HR- 1.31) and HFrEF (HR -, 1.24), but these associations did not reach statistical significance.

• Lower ppFVC was associated with incident HFpEF (HR - 1.21) but not with HFrEF (HR - 0.90).

The authors conclude that subclinical lung dysfunction in late life may help to identify older adults at increased risk of HF beyond traditional risk factors. The restrictive spirometric pattern in particular is associated with diastolic dysfunction and heightened risk of incident HFpEF, the most prevalent HF type in late life.

Prospective studies are needed to assess whether pulmonary dysfunction represents a modifiable risk factor for HF and whether interventions targeting pulmonary dysfunction would help decrease the risk of HF, and HFpEF in particular, in older adults.

Reference:

Sergio H. R. Ramalho, Brian L. Claggett, George R. WashkoJr, Raul San Jose Estepar, Patricia P. Chang, Dalane W. Kitzman, Gerson Cipriano Junior, Scott D. Solomon, Hicham Skali and Amil M. Shah. Originally published 5 Jul 2022. https://doi.org/10.1161/JAHA.121.023990. Journal of the American Heart Association. 2022;0:e023990.