Kim Jin-Jin, Kim Dong-Bin, Jang Sung-Won, Cho Eun Joo, Chang Kiyuk, Baek Sang Hong, Youn Ho-Joong, Chung Wook Sung, Seung Ki-Bae, Rho Tai-Ho, Jung Jung Im, Hwang Byung-Hee
Cardiovascular Center and Cardiology Division, St. Paul's Hospital, The Catholic University of Korea, 180, Wangsan-ro, Dongdaemun-gu, Seoul, 02559, Republic of Korea.
Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Int J Cardiovasc Imaging. 2018 Apr;34(4):641-648. doi: 10.1007/s10554-017-1259-z. Epub 2017 Nov 14.
Airflow obstruction is associated with increased cardiovascular morbidity and mortality. However, the causal mechanisms linking airflow obstruction with higher incidence of cardiovascular events remain elusive. We evaluated the relationship between airflow obstruction, a key feature of chronic obstructive pulmonary disease (COPD), and prevalence, extent, and severity of coronary atherosclerosis in a large cohort of asymptomatic subjects. Participants were recruited from those undergoing spirometry and coronary computed tomography angiography (CCTA) as part of a general health evaluation from March 2009 to February 2011. Subjects were required to be over 40 years of age with no known CAD. Airflow obstruction was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 70%. Obstructive CAD, as measured by CCTA, was defined as maximum intra-luminal stenosis ≥ 50%. Participants with airflow obstruction or normal lung function were compared in terms of obstructive CAD prevalence, the extent and severity of coronary atherosclerosis; including coronary artery calcium score (CACS), atheroma burden score (ABS), atheroma burden obstructive score (ABOS), segment involvement score (SIS), and segment stenosis score (SSS). A total of 1888 subjects were eligible for study inclusion. Compared with participants with normal lung function, those exhibiting airflow obstruction were more likely to have obstructive CAD (p = 0.002). Airflow obstruction was associated with higher CACS (p = 0.043), ABS (p = 0.002), ABOS (p = 0.017), SIS (p = 0.003), and SSS (p = 0.002). Multivariable analyses adjusted for conventional cardiovascular risk factors revealed that airflow obstruction was independently associated with presence of CAD (odds ratio 1.673, confidence intervals [CI] 1.002-2.789, p = 0.048). In this asymptomatic population, the presence of airflow obstruction was associated with a greater prevalence, extent, and severity of coronary atherosclerosis and was seen to be an independent predictor of the presence of CAD.
气流受限与心血管疾病发病率和死亡率的增加相关。然而，将气流受限与心血管事件较高发生率联系起来的因果机制仍不清楚。我们在一大群无症状受试者中评估了气流受限（慢性阻塞性肺疾病（COPD）的一个关键特征）与冠状动脉粥样硬化的患病率、范围和严重程度之间的关系。参与者是从2009年3月至2011年2月接受肺活量测定和冠状动脉计算机断层扫描血管造影（CCTA）作为一般健康评估一部分的人群中招募的。受试者年龄需超过40岁且无已知冠心病。气流受限定义为1秒用力呼气容积（FEV1）/用力肺活量（FVC）<70%。通过CCTA测量的阻塞性冠心病定义为最大管腔内狭窄≥50%。对有气流受限或肺功能正常的参与者在阻塞性冠心病患病率、冠状动脉粥样硬化的范围和严重程度方面进行了比较；包括冠状动脉钙化评分（CACS）、动脉粥样硬化斑块负荷评分（ABS）、动脉粥样硬化斑块负荷阻塞评分（ABOS）、节段累及评分（SIS）和节段狭窄评分（SSS）。共有1888名受试者符合研究纳入标准。与肺功能正常的参与者相比，出现气流受限的参与者更有可能患有阻塞性冠心病（p = 0.002）。气流受限与较高的CACS（p = 0.043）、ABS（p = 0.002）、ABOS（p = 0.017）、SIS（p = 0.003）和SSS（p = 0.002）相关。对传统心血管危险因素进行校正的多变量分析显示，气流受限与冠心病的存在独立相关（比值比1.673，置信区间[CI]1.002 - 2.789，p = 0.048）。在这个无症状人群中，气流受限的存在与冠状动脉粥样硬化的更高患病率、范围和严重程度相关，并且被视为冠心病存在的独立预测因素。
