Percent emphysema and right ventricular structure and function: The multi-ethnic study of atherosclerosis-lung and multi-ethnic study of atherosclerosis-right ventricle studies

Maria Grau, R. Graham Barr, Joao A. Lima, Eric A. Hoffman, David A. Bluemke, J. Jeffrey Carr, Harjit Chahal, Paul L. Enright, Aditya Jain, Martin R. Prince, Steven M. Kawut

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54 Scopus citations

Abstract

Background: Severe COPD can lead to cor pulmonale and emphysema and is associated with impaired left ventricular (LV) filling. We evaluated whether emphysema and airflow obstruction would be associated with changes in right ventricular (RV) structure and function and whether these associations would differ by smoking status. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) performed cardiac MRI on 5,098 participants without clinical cardiovascular disease aged 45 to 84 years. RV and emphysema measures were available for 4,188 participants. Percent emphysema was defined as the percentage of voxels below -910 Hounsfield units in the lung windows on cardiac CT scans. Generalized additive models were used to control for confounders and adjust for respective LV parameters. Results: Participants consisted of 13% current smokers, 36% former smokers, and 52% never smokers. Percent emphysema was inversely associated with RV end-diastolic volume, stroke volume, cardiac output, and mass prior to adjustment for LV measures. After adjustment for LV end-diastolic volume, greater percent emphysema was associated with greater RV end-diastolic volume (+1.5 mL, P = .03) among current smokers, smaller RV end-diastolic volume (-0.8 mL, P = .02) among former smokers, and similar changes among never smokers. Conclusions: Percent emphysema was associated with smaller RV volumes and lower mass. The relationship of emphysema to cardiac function is complex but likely involves increased pulmonary vascular resistance, predominantly with reduced cardiac output, pulmonary hyperinflation, and accelerated cardiopulmonary aging.

Original languageEnglish (US)
Pages (from-to)136-144
Number of pages9
JournalCHEST
Volume144
Issue number1
DOIs
StatePublished - Jul 2013

Bibliographical note

Funding Information:
Author contributions: Dr Barr is the guarantor of the study. Dr Grau: contributed to the study concept and design, data analysis and interpretation, writing of the article, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Barr: contributed to the study concept and design; data acquisition, analysis, and interpretation; critical revision of the manuscript for intellectual content; and final approval of the submitted manuscript. Dr Lima: contributed to the study concept and design, data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Hoffman: contributed to the study concept and design, data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Bluemke: contributed to the study concept and design, data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Carr: contributed to the data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Chahal: contributed to the data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Enright: contributed to the data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Jain: contributed to the data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Prince: contributed to the data acquisition, critical revision of the manuscript for intellectual content, and final approval of the submitted manuscript. Dr Kawut: contributed to the study concept and design; data acquisition, analysis, and interpretation; critical revision of the manuscript for intellectual content; and final approval of the submitted manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Barr is a principal investigator or coinvestigator on grants from National Institutes of Health (NIH), US-EPA, the Alpha-1 Foundation, and Columbia University; was reimbursed by Boehringer-Ingelheim GmbH for travel to the TransAtlantic Airways Conference; and received an in-kind donation of a nutritional supplement from Cenestra Health for an NIH-sponsored clinical trial. Dr Hoffman is a founder and shareholder of VIDA Diagnostics. Dr Prince has patent agreements with General Electric Company; Philips; Siemens; Hitachi, Ltd; Toshiba Corporation; Mallinckrodt Group; Nemoto & Co Ltd; Medrad Inc; Bayer; Bracco Imaging; Topspins Inc; and Lantheus Medical Imaging, who sell MRI-related products. Drs Grau, Lima, Bluemke, Carr, Chahal, Enright, Jain, and Kawut have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript. Other contributions: This manuscript has been reviewed by the MESA Investigators for scientific content and consistency of data interpretation with previous MESA publications and significant comments have been incorporated prior to submission for publication. The authors thank the other investigators, staff, and participants of the MESA, MESA-Lung, and MESA Right Ventricle studies for their valuable contributions. Additional information: The e-Appendix and e-Tables can be found in the “Supplemental Materials” area of the online article.

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