Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2013 Jul;144(1):136-144.
doi: 10.1378/chest.12-1779.

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  1 , R Graham Barr  2 , Joao A Lima  3 , Eric A Hoffman  4 , David A Bluemke  5 , J Jeffrey Carr  6 , Harjit Chahal  3 , Paul L Enright  7 , Aditya Jain  3 , Martin R Prince  8 , Steven M Kawut  9
Affiliations
Multicenter Study

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 et al. Chest. 2013 Jul.

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow diagram of participant selection in the MESA study. LV = left ventricular; MESA = Multi-Ethnic Study of Atherosclerosis; RV = right ventricular.
Figure 2.
Figure 2.
Relationship between RV end-diastolic volume and % emphysema across smoking categories. Models were adjusted for age, weight, height, sex, race/ethnicity, CT scanner type and tube current in milliamperes, cigarettes per day (only current smokers), pack-y of smoking (only current and former smokers), glucose, diabetes (physician diagnosis or treatment), systolic and diastolic BP, hypertension (physician diagnosis or treatment), educational attainment, fibrinogen, and C-reactive protein. See Figure 1 legend for expansion of abbreviations.
Figure 3.
Figure 3.
Relationship between RV end-diastolic volume and % emphysema across smoking categories after adjustment for respective left ventricular parameters. Models were adjusted for age, weight, height, sex, race/ethnicity, CT scanner type and tube current in milliamperes, left ventricular end-diastolic volume, cigarettes per day (only current smokers), pack-y of smoking (only current and former smokers), glucose, diabetes (physician diagnosis or treatment), systolic and diastolic BP, hypertension (physician diagnosis or treatment), educational attainment, fibrinogen, and C-reactive protein. See Figure 1 legend for expansion of abbreviations.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. National Center for Health Statistics, Centers for Disease Control and Prevention National vital statistics reports. Deaths: preliminary data for 2008. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_02.pdf Accessed June 20, 2011.
    1. Celli BR, MacNee W; ATS/ERS Task Force Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932-946 - PubMed
    1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS; GOLD Scientific Committee Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256-1276 - PubMed
    1. Peinado VI, Pizarro S, Barberà JA. Pulmonary vascular involvement in COPD. Chest. 2008;134(4):808-814 - PubMed
    1. MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part one. Am J Respir Crit Care Med. 1994;150(3):833-852 - PubMed

Publication types

MeSH terms