Impaired left ventricular filling in COPD and emphysema

Is it the heart or the lungs?: The multi-ethnic study of atherosclerosis COPD study

Benjamin M. Smith, Martin R. Prince, Eric A. Hoffman, David A. Bluemke, Chia Ying Liu, Dan Rabinowitz, Katja Hueper, Megha A. Parikh, Antoinette S. Gomes, Erin Donnelly Michos, Joao Lima, R. Graham Barr

Research output: Contribution to journalArticle

Abstract

Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions, <-10 Hounsfield units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean (±SD) total pulmonary vein area was 558 ± 159 mm2 in patients with COPD and 623 ± 145 mm2 in control subjects. Total pulmonary vein area was smaller in patients with COPD (2 57 mm2 ; 95% CI, 2 106 to 2 7 mm2 ; P = .03) and inversely associated with percent emphysema (P <.001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defined COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan.

Original languageEnglish (US)
Pages (from-to)1143-1151
Number of pages9
JournalChest
Volume144
Issue number4
DOIs
StatePublished - Oct 2013

Fingerprint

Emphysema
Chronic Obstructive Pulmonary Disease
Atherosclerosis
Pulmonary Veins
Lung
Spirometry
Body Size
Left Ventricular Dysfunction
Linear Models
Cardiovascular Diseases
Magnetic Resonance Spectroscopy
Heart Failure
Smoking

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Smith, B. M., Prince, M. R., Hoffman, E. A., Bluemke, D. A., Liu, C. Y., Rabinowitz, D., ... Barr, R. G. (2013). Impaired left ventricular filling in COPD and emphysema: Is it the heart or the lungs?: The multi-ethnic study of atherosclerosis COPD study. Chest, 144(4), 1143-1151. https://doi.org/10.1378/chest.13-0183

Impaired left ventricular filling in COPD and emphysema : Is it the heart or the lungs?: The multi-ethnic study of atherosclerosis COPD study. / Smith, Benjamin M.; Prince, Martin R.; Hoffman, Eric A.; Bluemke, David A.; Liu, Chia Ying; Rabinowitz, Dan; Hueper, Katja; Parikh, Megha A.; Gomes, Antoinette S.; Michos, Erin Donnelly; Lima, Joao; Barr, R. Graham.

In: Chest, Vol. 144, No. 4, 10.2013, p. 1143-1151.

Research output: Contribution to journalArticle

Smith, BM, Prince, MR, Hoffman, EA, Bluemke, DA, Liu, CY, Rabinowitz, D, Hueper, K, Parikh, MA, Gomes, AS, Michos, ED, Lima, J & Barr, RG 2013, 'Impaired left ventricular filling in COPD and emphysema: Is it the heart or the lungs?: The multi-ethnic study of atherosclerosis COPD study', Chest, vol. 144, no. 4, pp. 1143-1151. https://doi.org/10.1378/chest.13-0183
Smith, Benjamin M. ; Prince, Martin R. ; Hoffman, Eric A. ; Bluemke, David A. ; Liu, Chia Ying ; Rabinowitz, Dan ; Hueper, Katja ; Parikh, Megha A. ; Gomes, Antoinette S. ; Michos, Erin Donnelly ; Lima, Joao ; Barr, R. Graham. / Impaired left ventricular filling in COPD and emphysema : Is it the heart or the lungs?: The multi-ethnic study of atherosclerosis COPD study. In: Chest. 2013 ; Vol. 144, No. 4. pp. 1143-1151.
@article{e085d42dde1f4dd5a482720f850cf4e2,
title = "Impaired left ventricular filling in COPD and emphysema: Is it the heart or the lungs?: The multi-ethnic study of atherosclerosis COPD study",
abstract = "Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions, <-10 Hounsfield units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean (±SD) total pulmonary vein area was 558 ± 159 mm2 in patients with COPD and 623 ± 145 mm2 in control subjects. Total pulmonary vein area was smaller in patients with COPD (2 57 mm2 ; 95{\%} CI, 2 106 to 2 7 mm2 ; P = .03) and inversely associated with percent emphysema (P <.001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defined COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan.",
author = "Smith, {Benjamin M.} and Prince, {Martin R.} and Hoffman, {Eric A.} and Bluemke, {David A.} and Liu, {Chia Ying} and Dan Rabinowitz and Katja Hueper and Parikh, {Megha A.} and Gomes, {Antoinette S.} and Michos, {Erin Donnelly} and Joao Lima and Barr, {R. Graham}",
year = "2013",
month = "10",
doi = "10.1378/chest.13-0183",
language = "English (US)",
volume = "144",
pages = "1143--1151",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "4",

}

TY - JOUR

T1 - Impaired left ventricular filling in COPD and emphysema

T2 - Is it the heart or the lungs?: The multi-ethnic study of atherosclerosis COPD study

AU - Smith, Benjamin M.

AU - Prince, Martin R.

AU - Hoffman, Eric A.

AU - Bluemke, David A.

AU - Liu, Chia Ying

AU - Rabinowitz, Dan

AU - Hueper, Katja

AU - Parikh, Megha A.

AU - Gomes, Antoinette S.

AU - Michos, Erin Donnelly

AU - Lima, Joao

AU - Barr, R. Graham

PY - 2013/10

Y1 - 2013/10

N2 - Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions, <-10 Hounsfield units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean (±SD) total pulmonary vein area was 558 ± 159 mm2 in patients with COPD and 623 ± 145 mm2 in control subjects. Total pulmonary vein area was smaller in patients with COPD (2 57 mm2 ; 95% CI, 2 106 to 2 7 mm2 ; P = .03) and inversely associated with percent emphysema (P <.001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defined COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan.

AB - Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions, <-10 Hounsfield units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean (±SD) total pulmonary vein area was 558 ± 159 mm2 in patients with COPD and 623 ± 145 mm2 in control subjects. Total pulmonary vein area was smaller in patients with COPD (2 57 mm2 ; 95% CI, 2 106 to 2 7 mm2 ; P = .03) and inversely associated with percent emphysema (P <.001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defined COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan.

UR - http://www.scopus.com/inward/record.url?scp=84885162052&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885162052&partnerID=8YFLogxK

U2 - 10.1378/chest.13-0183

DO - 10.1378/chest.13-0183

M3 - Article

VL - 144

SP - 1143

EP - 1151

JO - Chest

JF - Chest

SN - 0012-3692

IS - 4

ER -