Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, McGill University, Montreal, QC, Canada.
Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY.
Chest. 2013 Oct;144(4):1143-1151. doi: 10.1378/chest.13-0183.
COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload.
The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions < -910 Hounsfield units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking.
Among 165 participants, the mean (± SD) total pulmonary vein area was 558 ± 159 mm2 in patients with COPD and 623 ± 145 mm2 in control subjects. Total pulmonary vein area was smaller in patients with COPD (-57 mm2; 95% CI, -106 to -7 mm2; P = .03) and inversely associated with percent emphysema (P < .001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defined COPD.
Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan.
COPD 和射血分数保留的心力衰竭在临床上有重叠，COPD 常伴有左心室（LV）充盈受损。这些观察结果的机制尚不确定，但可能包括上游肺功能障碍导致 LV 前负荷降低，或固有 LV 功能障碍导致 LV 前负荷升高。本研究旨在确定 COPD 和肺气肿是否与提示 LV 前负荷降低的肺静脉尺寸减小有关。
基于人群的动脉粥样硬化多民族研究（MESA）COPD 研究招募了年龄在 50 至 79 岁、无临床心血管疾病的吸烟者。COPD 通过肺活量测定法定义。肺气肿百分比定义为全肺 CT 扫描上区域 <-910 个 Hounsfield 单位。对比增强心脏磁共振测量肺静脉口截面积，并表示为所有肺静脉面积的总和。线性回归用于调整年龄、性别、种族/民族、体型和吸烟状况。
在 165 名参与者中，COPD 患者的总肺静脉面积平均值（±标准差）为 558 ± 159 mm2，对照组为 623 ± 145 mm2。COPD 患者的总肺静脉面积较小（-57 mm2；95%置信区间，-106 至-7 mm2；P =.03），在完全调整模型中与肺气肿百分比呈负相关（P <.001）。在仅 COPD 患者、CT 扫描显示 COPD 合并肺气肿和影像学定义的 COPD 无肺气肿的患者中，总肺静脉面积均有显著减少。
COPD 和肺气肿患者的肺静脉尺寸减小。这些发现支持 COPD 和 CT 扫描显示肺气肿患者 LV 充盈不足的上游肺源性机制。
