Pulmonary function and adverse cardiovascular outcomes: Can cardiac function explain the link?

Respir Med. 2016 Dec:121:4-12. doi: 10.1016/j.rmed.2016.10.009. Epub 2016 Oct 18.

Abstract

Background: The complex interaction between pulmonary function, cardiac function and adverse cardiovascular events has only been partially described. We sought to describe the association between pulmonary function with left heart structure and function, all-cause mortality and incident cardiovascular hospitalization.

Methods: This study is a retrospective analysis of patients evaluated in a single tertiary care medical center. We used multivariable linear regression analyses to examine the relationship between FVC and FEV1 with left ventricular ejection fraction (LVEF), left ventricular internal dimension in systole and diastole (LVIDS, LVIDD) and left atrial diameter, adjusting for baseline characteristics, right ventricular function and lung hyperinflation. We also used Cox proportional hazards models to examine the relationship between FVC and FEV1 with all-cause mortality and cardiac hospitalization.

Results: A total of 1807 patients were included in this analysis with a median age of 61 years and 50% were female. Decreased FVC and FEV1 were both associated with decreased LVEF. In individuals with FVC less than 2.75 L, decreased FVC was associated with increased all-cause mortality after adjusting for left and right heart echocardiographic variables (hazard ratio [HR] 0.49, 95% CI 0.29, 0.82, respectively). Decreased FVC was associated with increased cardiac hospitalization after adjusting for left heart size (HR 0.80, 95% CI 0.67, 0.96), even in patients with normal LVEF (HR 0.75, 95% CI 0.57, 0.97).

Conclusion: In a tertiary care center reduced pulmonary function was associated with adverse cardiovascular events, a relationship that is not fully explained by left heart remodeling or right heart dysfunction.

Keywords: Cardiovascular disease; Echocardiography; Pulmonary function; Spirometry.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Diseases / diagnostic imaging
  • Cardiovascular Diseases / physiopathology*
  • Echocardiography
  • Female
  • Forced Expiratory Volume / physiology
  • Heart Atria / diagnostic imaging
  • Heart Atria / pathology
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / pathology
  • Hospitalization / statistics & numerical data
  • Humans
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Mortality
  • North Carolina / epidemiology
  • Retrospective Studies
  • Stroke Volume / physiology
  • Ventricular Function, Left / physiology
  • Vital Capacity / physiology