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Percent emphysema and right ventricular structure and function: the Multi-Ethnic Study of Atherosclerosis-Lung and Multi-Ethnic Study of Atherosclerosis-Right Ventricle Studies.

Grau M, Barr RG, Lima JA, Hoffman EA, Bluemke DA, Carr JJ, Chahal H, Enright PL, Jain A, Prince MR, Kawut SM
Chest. 2013 144 (1): 136-144

PMID: 23450302 · PMCID: PMC3704233 · DOI:10.1378/chest.12-1779

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.

MeSH Terms (21)

African Continental Ancestry Group Aged Aged, 80 and over Asian Continental Ancestry Group Cohort Studies European Continental Ancestry Group Female Heart Ventricles Hispanic Americans Humans Lung Magnetic Resonance Imaging Male Middle Aged Prevalence Prospective Studies Pulmonary Emphysema Smoking Spirometry Tomography, X-Ray Computed Ventricular Dysfunction, Right

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