Abstract：
We performed a systematic review and meta-analysis to detect the impact of chronic obstructive pulmonary disease (COPD) on the prognosis of heart failure patients with preserved ejection fraction (HFpEF). We systematically screened eligible literature from three electronic databases, PubMed, EMBASE and Cochrane Library, up to April 2023. Two researchers participated in data collection independently. Risk ratios (RRs) from included studies with 95% confidence intervals (CIs) were pooled in the Review Manager version 5.40 software using a random-effects model for analysis. A total of 11 studies (3 post hoc analyses of RCTs and 8 observational studies) with 18 602 participants were included in this meta-analysis. After pooling all the data from eligible studies, our results indicated that COPD was associated with an increased risk of hospitalization (RR = 1.66, 95% CI, 1.47-1.87, P < 0.00001), mortality (RR = 1.62, 95% CI, 1.34-1.95, P < 0.00001), and the composition of hospitalization or mortality (RR = 1.84, 95% CI, 1.35-2.51, P < 0.001) in patients with HFpEF. In a subgroup analysis, the risks of cardiovascular-related mortality (RR = 1.59, 95% CI, 1.30-1.93, P < 0.00001) and post-discharge mortality risk (RR = 2.57, 1.34-4.93, P < 0.01) were increased in HFpEF patients comorbid with COPD, and these associations were also detected in HF-caused hospitalization (RR = 1.64, 95% CI, 1.44-1.87, P < 0.00001). Evidence from existing studies supported that COPD was an independent prognostic risk factor for patients with HFpEF. Developing rapid clinical diagnostic indicators and early use of novel drugs such as SGLT-2 and ARNI may improve the prognosis of this population, deserving further study.
摘要：
我们进行了系统评价和荟萃分析，以检测慢性阻塞性肺疾病（COPD）对射血分数保留（HFpEF）的心力衰竭患者预后的影响。我们从三个电子数据库中系统地筛选了符合条件的文献，PubMed,EMBASE和Cochrane图书馆，到2023年4月。两名研究人员独立参与了数据收集。纳入研究的风险比（RR）与95％置信区间（CI）汇集在审查管理器版本5.40软件使用随机效应模型进行分析。本荟萃分析共纳入11项研究（3项RCT事后分析和8项观察性研究），其中18.602名参与者。汇集所有符合条件的研究数据后，我们的结果表明COPD与住院风险增加相关(RR=1.66,95%CI,1.47-1.87,P<0.00001),死亡率（RR=1.62，95%CI，1.34-1.95，P<0.00001），HFpEF患者的住院率或死亡率构成(RR=1.84,95%CI,1.35-2.51,P<0.001)。在亚组分析中，合并COPD的HFpEF患者的心血管相关死亡风险(RR=1.59,95%CI,1.30-1.93,P<0.00001)和出院后死亡风险(RR=2.57,1.34-4.93,P<0.01)增加,在HF导致的住院中也检测到这些关联(RR=1.64,95%CI,1.44-1.87,P<0.00001).现有研究的证据支持COPD是HFpEF患者的独立预后危险因素。开发快速的临床诊断指标和早期使用SGLT-2和ARNI等新药可能会改善该人群的预后。值得进一步研究。
