BackgroundLittle is known about the impact of chronic obstructive pulmonary disease (COPD) in patients with heart failure with preserved ejection fraction (HFpEF).Methods and ResultsWe examined outcomes in patients with heart failure with preserved ejection fraction, according to COPD status, in the PARAGON‐HF (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and cardiovascular death. Of 4791 patients, 670 (14%) had COPD. Patients with COPD were more likely to be men (58% versus 47%; P<0.001) and had worse New York Heart Association functional class (class III/IV 24% versus 19%), worse Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores (69 versus 76; P<0.001) and more frequent history of heart failure hospitalization (54% versus 47%; P<0.001). The decrement in Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores with COPD was greater than for other common comorbidities. Patients with COPD had echocardiographic right ventricular enlargement, higher serum creatinine (100 μmol/L versus 96 μmol/L) and neutrophil‐to‐lymphocyte ratio (2.7 versus 2.5), than those without COPD. After multivariable adjustment, COPD was associated with worse outcomes: adjusted rate ratio for the primary outcome 1.51 (95% CI, 1.25–1.83), total heart failure hospitalization 1.54 (95% CI, 1.24–1.90), cardiovascular death (adjusted hazard ratio [HR], 1.42; 95% CI, 1.10–1.82), and all‐cause death (adjusted HR, 1.52; 95% CI, 1.25–1.84). COPD was associated with worse outcomes than other comorbidities and Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores declined more in patients with COPD than in those without.ConclusionsApproximately 1 in 7 patients with heart failure with preserved ejection fraction had concomitant COPD, which was associated with greater functional limitation and a higher risk of heart failure hospitalization and death.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.

中文翻译：

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慢性阻塞性肺疾病对射血分数保留的心力衰竭患者的影响：来自 PARAGON-HF 的见解

背景 关于慢性阻塞性肺疾病 (COPD) 对射血分数保留的心力衰竭 (HFpEF) 患者的影响知之甚少。 ‐HF（血管紧张素受体脑啡肽酶抑制剂与血管紧张素受体阻滞剂在射血分数保留的心力衰竭中的全球结局前瞻性比较）试验。主要结局是因心力衰竭和心血管死亡而首次住院和再次住院的综合结果。在 4791 名患者中，670 名 (14%) 患有 COPD。COPD 患者更可能是男性（58% 对 47%；P<0.001) 并且纽约心脏协会心功能分级更差（III/IV 级 24% 对 19%），堪萨斯城心肌病问卷临床总结评分更差（69 对 76；P <0.001）和更频繁的心力衰竭住院史（ 54% 对 47%；P<0.001)。COPD 的堪萨斯城心肌病问卷临床总结评分的下降幅度大于其他常见合并症。与没有 COPD 的患者相比，COPD 患者的超声心动图右心室增大，血清肌酐（100 μmol/L 对 96 μmol/L）和中性粒细胞与淋巴细胞比值（2.7 对 2.5）更高。多变量调整后，COPD 与更差的结果相关：主要结果的调整比率为 1.51（95% CI，1.25-1.83），总心力衰竭住院率 1.54（95% CI，1.24-1.90），心血管死亡（调整后的风险比[HR]，1.42；95% CI，1.10–1.82）和全因死亡（调整后的 HR，1.52；95% CI，1.25–1.84）。COPD 与其他合并症和堪萨斯城心肌病问卷临床总结评分相比，与其他合并症相比，预后更差限制和更高的心力衰竭住院和死亡风险。RegistrationURL：https://www.clinicaltrials.gov；唯一标识符：NCT01920711。