Arterial vascular pruning, right ventricular size, and clinical outcomes in chronic obstructive pulmonary disease. A longitudinal observational study
GR Washko, P Nardelli, SY Ash… - American journal of …, 2019 - atsjournals.org
American journal of respiratory and critical care medicine, 2019•atsjournals.org
Rationale: Cor pulmonale (right ventricular [RV] dilation) and cor pulmonale parvus (RV
shrinkage) are both described in chronic obstructive pulmonary disease (COPD). The
identification of emphysema as a shared risk factor suggests that additional disease
characterization is needed to understand these widely divergent cardiac processes.
Objectives: To explore the relationship between computed tomography measures of
emphysema and distal pulmonary arterial morphology with RV volume, and their association …
shrinkage) are both described in chronic obstructive pulmonary disease (COPD). The
identification of emphysema as a shared risk factor suggests that additional disease
characterization is needed to understand these widely divergent cardiac processes.
Objectives: To explore the relationship between computed tomography measures of
emphysema and distal pulmonary arterial morphology with RV volume, and their association …
Rationale: Cor pulmonale (right ventricular [RV] dilation) and cor pulmonale parvus (RV shrinkage) are both described in chronic obstructive pulmonary disease (COPD). The identification of emphysema as a shared risk factor suggests that additional disease characterization is needed to understand these widely divergent cardiac processes.
Objectives: To explore the relationship between computed tomography measures of emphysema and distal pulmonary arterial morphology with RV volume, and their association with exercise capacity and mortality in ever-smokers with COPD enrolled in the COPDGene Study.
Methods: Epicardial (myocardium and chamber) RV volume (RVEV), distal pulmonary arterial blood vessel volume (arterial BV5: vessels <5 mm2 in cross-section), and objective measures of emphysema were extracted from 3,506 COPDGene computed tomography scans. Multivariable linear and Cox regression models and the log-rank test were used to explore the association between emphysema, arterial BV5, and RVEV with exercise capacity (6-min-walk distance) and all-cause mortality.
Measurements and Main Results: The RVEV was approximately 10% smaller in Global Initiative for Chronic Obstructive Lung Disease stage 4 versus stage 1 COPD (P < 0.0001). In multivariable modeling, a 10-ml decrease in arterial BV5 (pruning) was associated with a 1-ml increase in RVEV. For a given amount of emphysema, relative preservation of the arterial BV5 was associated with a smaller RVEV. An increased RVEV was associated with reduced 6-minute-walk distance and in those with arterial pruning an increased mortality.
Conclusions: Pulmonary arterial pruning is associated with clinically significant increases in RV volume in smokers with COPD and is related to exercise capacity and mortality in COPD.
Clinical trial registered with www.clinicaltrials.gov (NCT 00608764).
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