Differential impact of obstructive and restrictive ventilatory patterns on incident heart failure with preserved versus reduced ejection fraction in late-life

Abstract Background Subclinical pulmonary dysfunction predicts cardiovascular (CV) outcomes, especially heart failure (HF). However, the impact of reduced percent predicted forced vital capacity (ppFVC) and forced expired volume in 1 second (FEV1)/FVC on different incident HF phenotypes in late-life is unclear. Purpose Determine the associations of FEV1/FVC and ppFVC with incident HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction in late-life. Methods In the Atherosclerosis Risk in Communities longitudinal cohort study, 3,854 HF-free participants who underwent echocardiography and spirometry at the fifth study visit (2011–2013). The relation between pulmonary function and incident adjudicated HFpEF and HFrEF were examined using multivariable Cox proportional hazards models adjusted for demographics, body mass index, coronary artery disease, atrial fibrillation, hypertension, diabetes, and NT-proBNP. Results Mean age was 75±5 years, 40% were male, 19% black, and 6% current smokers. Mean FEV1/FVC was 72±8, and ppFVC was 98±17%. At a median follow-up of 5.6 years, lower ppFVC was independently associated with incident HFpEF, but not HFrEF (Table). Lower FEV1/FVC ratio was associated with higher risk of incident HFrEF but not HFpEF in models adjusted for demographics, which did not persist after further adjustment for clinical risk factors. Conclusion The relationships of reduced ppFVC and FEV1/FVC with incident HF differ significantly by HF phenotype. Table 1. Lung dysfunction and incident HF Spirometry variable Outcomes Incident HFpEF (98 events) Incident HFrEF (76 events) HR (95% CI) p-value HR (95% CI) p-value FEV1/FVC Model 1 1.18 (0.94–1.48) 0.15 1.34 (1.06–1.69) 0.01 Model 2 1.11 (0.87–1.42) 0.42 1.24 (0.97–1.56) 0.09 ppFVC Model 1 1.32 (1.15–1.51)