Original Research: COPD |

Percent Emphysema and Right Ventricular Structure and FunctionEmphysema and Right Ventricular Function: The Multi-Ethnic Study of Atherosclerosis-Lung and Multi-Ethnic Study of Atherosclerosis-Right Ventricle Studies

Maria Grau, MD, PhD, MPH; R. Graham Barr, MD, DrPH; Joao A. Lima, MD; Eric A. Hoffman, PhD; David A. Bluemke, MD, PhD; J. Jeffrey Carr, MD; Harjit Chahal, MD, PhD; Paul L Enright, MD; Aditya Jain, MD; Martin R. Prince, MD, PhD; Steven M. Kawut, MD, FCCP*
Author and Funding Information

From the Department of Medicine (Drs Grau and Barr), the Department of Epidemiology (Dr Barr), and the Department of Radiology (Dr Prince), Columbia University Medical Center, New York, NY; the Department of Medicine (Drs Lima, Chahal, and Jain), Johns Hopkins University, Baltimore, MD; National Institutes of Health Clinical Center (Dr Bluemke), Bethesda, MD; University of Iowa (Dr Hoffman), Iowa City, IA; Wake Forest University (Dr Carr), Winston-Salem, NC; University of Arizona (Dr Enright), Tucson, AZ; Penn Cardiovascular Institute, Department of Medicine and Center for Clinical Epidemiology and Biostatistics (Dr Kawut), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and the Cardiovascular Epidemiology and Genetics Group (Dr Grau), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.

Correspondence to R. Graham Barr, MD, DrPH, Department of Medicine, Columbia University Medical Center, 630 W 168th St, PH 9 E-Room 105, New York, NY 10032; e-mail: rgb9@columbia.edu


A full list of investigators and institutions participating in the Multi-Ethnic Study of Atherosclerosis (MESA) can be found at www.mesa-nhlbi.org.

Funding/Support: The MESA, MESA-Lung, and MESA-Right Ventricle Studies are conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) [Contracts N01-HC-95159-N01-HC-95169 and Grants R01 HL077612, R01 HL086719, R01 HL075476, and RC1 HL100543] in collaboration with the MESA, MESA-Lung, and MESA-Right Ventricle investigators. Dr Kawut was supported by the NHLBI [K24 HL103844]. Dr Grau was funded by grants from Health Institute Carlos III-FEDER, Spain [Red HERACLES RD06/0009, CM08/00141, and CP12/03287].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(1):136-144. doi:10.1378/chest.12-1779
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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.

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