Pulmonary Function, Chronic Obstructive Pulmonary Disease (COPD) Prevalence, and Systemic Inflammation in Chronic Heart Failure With or Without COPD
Pulmonary Function, Chronic Obstructive Pulmonary Disease (COPD) Prevalence, and Systemic Inflammation in Chronic Heart Failure With or Without COPD
The aim of the present study is:

 1. To investigate pulmonary function abnormalities (restriction, obstruction, diffusion
 impairment, mixed pulmonary defects) in patients with chronic heart failure (CHF) and to
 determine which of these pulmonary abnormalities prevail and to what extent.

 2. To determine the prevalence, underdiagnosis, and overdiagnosis of chronic obstructive
 pulmonary disease (COPD) as determined by spirometry and according to Global Initiative
 for Chronic Obstructive Lung Disease (GOLD) criteria in patients with CHF.

 3. To investigate the presence of systemic inflammation, as measured by inflammatory
 parameters (leukocytes, platelets, high sensitivity CRP), in CHF patients with or
 without COPD.
1. The impact of chronic heart failure (CHF) on pulmonary function is incompletely
 understood and remains controversial. It is difficult to separate the contribution of
 stable CHF from underlying pulmonary disease and other confounding influences, such as
 changes due to normal ageing, obesity, environmental exposure (mainly smoking),
 stability of disease, a history of coronary artery bypass grafting, and other conditions
 that can lead to pulmonary function abnormalities. Studies have shown that isolated or
 combined pulmonary function impairment, such as diffusion impairment, restriction, and
 to a much lesser extent airway obstruction are common in patients with CHF and can
 contribute to the perception of dyspnoea and exercise intolerance. Pulmonary dysfunction
 increases with the severity of heart failure and provides important prognostic
 information. Most investigators compared pulmonary function in CHF patients with normal
 predicted values or control subjects. However, there is only a small body of literature
 addressing the prevalence of different pulmonary function abnormalities in patients with
 CHF. In addition, these studies have included (potential) heart transplant recipients,
 who represent one extreme of the heart failure spectrum. The aim of the present study
 was to investigate the prevalence of pulmonary function abnormalities in patients with
 CHF and to determine which of these pulmonary abnormalities prevail and to what extent.

 2. Chronic obstructive pulmonary disease (COPD) frequently coexists with CHF, leading to
 impaired prognosis as well as diagnostic and therapeutic challenges. However, lung
 functional data on COPD prevalence in CHF are scarce and COPD remains widely undiagnosed
 or misdiagnosed. The reported prevalence rates of COPD range from 9 to 41% in European
 cohorts and from 11 to 52% in North American patients with heart failure. The purpose of
 this study was to determine the prevalence, underdiagnosis, and overdiagnosis of COPD as
 determined by spirometry and according to Global Initiative for Chronic Obstructive Lung
 Disease (GOLD) criteria in patients with CHF.

 3. There is abundant evidence of increased systemic inflammation in both CHF and COPD and
 it is remarkable to observe the similarities of inflammation in both conditions. These
 inflammatory responses may provide a mechanistic bridge between COPD and cardiac
 co-morbidity. However, there is no information regarding systemic inflammation when CHF
 and COPD coexist. It is unknown whether the combination of these two diseases leads to
 increased systemic inflammation in comparison to CHF alone. The aim of this study was to
 investigate the presence of systemic inflammation, as measured by inflammatory
 parameters (leukocytes, platelets, high sensitivity CRP), in CHF patients with or
 without COPD.
Inclusion Criteria:

 -  Chronic heart failure patients with left ventricular systolic dysfunction (left
 ventricular ejection fraction < 40%)

 -  Outpatients

 -  New York Heart Association (NYHA) class I-IV

 -  18 years and older

 -  Informed consent

 Exclusion Criteria:

 -  Patients who do not meet the inclusion criteria

 -  Patients who are not able to cooperate or undergo pulmonary function tests

 -  Other diseases that can lead to obstructive lung function: asthma, cystic fibrosis

 -  Malignancy with bad prognosis (survival < 6 months)

 -  Hospitalisation to the pulmonary department in the past 6 weeks, in this case patients
 will have the pulmonary function tests ≥ 6 weeks after discharge

 -  Patients who are already participating in another study within the cardiology
 department

 Additional exclusion criteria for the first primary objective:

 -  Disorders/diseases that can lead to pulmonary function impairment:

 -  Pulmonary: lung surgery (lobectomy/pneumectomy), parenchymal neoplasms,
 interstitial lung disease, sarcoidosis, pneumoconioses, lung abscess, lobar
 pneumonia, post- infectious scarring, atelectasis, radiation fibrosis

 -  Pleural: diffuse pleural thickening, mesothelioma, pleural effusion not due to
 heart failure, pneumothorax

 -  Neuromuscular diseases: ALS, poliomyelitis, myopathy, bilateral diaphragmatic
 paralysis, high spinal cord lesions, myasthenia gravis

 -  Abdominal: obesity (BMI > 35) (exclusion only from the restriction prevalence
 analysis)

 -  Pericardial: major pericardial effusion

 -  Large mediastinal processes

 -  Collagen vascular diseases

 Additional exclusion criteria for the third primary objective:

 -  Active/recent infection

 -  Febrile or inflammatory disease such as rheumatoid arthritis

 -  Use of antibiotics or anti-inflammatory medication, such as etanercept, infliximab,
 systemic use of corticosteroids and NSAID's other than acetylsalicylic acid

 -  Malignancy

 -  Auto-immune disease

 -  Collagenvascular disease

 -  Gastro-intestinal disease (such as inflammatory bowel disease)

 -  Recent operation (past 3 months)

 -  Renal or liver failure

 -  Thyroid disease

 -  Obstructive sleep apnoea syndrome (OSAS)

 -  Disorders that lead to thrombocytopenia/leukocytopenia or thrombocytosis/leukocytosis
 (hs-CRP analysis will take place in case these disorders do not affect hs-CRP)