TY - JOUR
TI - Comparison between ATS/ERS age- and gender-adjusted criteria and GOLD
criteria for the detection of irreversible airway obstruction in chronic
heart failure
AU - Steinacher, Richard
AU - Parissis, John T.
AU - Strohmer, Bernhard and
AU - Eichinger, Joerg
AU - Rottlaender, Dennis
AU - Hoppe, Uta C. and
AU - Altenberger, Johann
JO - Clinical Research in Cardiology
PY - 2012
VL - 101
TODO - 8
SP - 637-645
PB - Springer Berlin Heidelberg
SN - 1861-0684, 1861-0692
TODO - 10.1007/s00392-012-0438-0
TODO - Heart failure; Chronic obstructive pulmonary disease; Spirometry;
Diagnosis; Airway obstruction
TODO - Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria
(FEV1/FVC < 70%) are extensively used for diagnosis of chronic
obstructive lung disease in heart failure (HF). The American Thoracic
Society (ATS)/European Respiratory Society (ERS) recommends the use of
age- and gender-specific lower limit of normal (LLN) for FEV1/FVC. We
compared the impact of these definitions on apparent prevalence of
airway obstruction in chronic HF.
Standardized pre- and post-bronchodilator spirometry was performed in HF
patients. Airway obstruction was defined by ATS/ERS criteria as
diagnostic standard. Additionally, airway obstruction was calculated
using the GOLD criteria.
Of the 89 participants who fulfilled the ATS criteria for acceptability
and reproducibility, 24.7% met ATS/ERS and 43.8% GOLD criteria for
airway obstruction (Chi-square p = 0.007, McNemar < 0.001). Sensitivity
of GOLD criteria was 100%, specificity 74.6%, positive predictive
value 56.4% and negative predictive value 100%. Among all individuals
with an FEV1/FVC > LLN, 25.4% were falsely identified when using the
GOLD criteria. A majority of false positives qualified for airway
obstruction GOLD stage I (FEV1% a parts per thousand yen80%), which
was significantly less often observed among true positives (76.5 vs.
31.8%; p < 0.001). Only 31.8% of patients with irreversible airway
obstruction detected by the ATS/ERS criteria reported a history of COPD.
In all HF patients with persistent dyspnoea despite optimal HF
treatment, spirometric testing should be performed. Application of the
GOLD criteria leads to overdiagnosis of irreversible airway obstruction
in patients with HF, which may result in inappropriate medical therapy
and health-care decisions.
ER -