From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.).
Radiology. 2020 Jul;296(1):208-215. doi: 10.1148/radiol.2020191793. Epub 2020 May 5.
Background Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LV, distal pulmonary venous blood volume for vessels smaller than 5 mm in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LV as well as the association of LV with health status using the St George's Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results The median age of the cohort was 64 years (interquartile range, 57-70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men ( < .001 for both). In fully adjusted models, higher emphysema percentage (β = -4.2; 95% confidence interval [CI]: -5.0, -3.4; < .001), venous BV5 (β = 7.0; 95% CI: 5.7, 8.2; < .001), and pectoralis muscle area (β = 2.7; 95% CI: 1.2, 4.1; < .001) were independently associated with reduced LV. Reductions in LV were associated with improved health status (β = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (β = -12.2; 95% CI: -15.2, -9.3). These effects were greater in women than in men. The effect of reduced LV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality. © RSNA, 2020
背景 患有慢性阻塞性肺疾病（COPD）的吸烟者由于前负荷减少，左心室（LV）较小。COPD 也常见骨骼肌消耗，但对其与 LV 大小的关系知之甚少。目的 探讨 COPD 患者胸部 CT 图像上肺气肿 CT 指标、静脉血管容量和骨骼肌减少与 LV 心外膜容积（LV）（心肌和心室）之间的关系，然后确定 LV 在包括性别和人体测量指标在内的多变量模型中的临床相关性。材料与方法 COPDGene 研究（ClinicalTrials.gov 标识符：NCT00608764）是一项正在进行的前瞻性纵向观察研究，于 2006 年开始。从 3318 例非门控、未增强的 COPDGene CT 扫描中回顾性提取 LV、远端肺动脉小血管（直径<5mm）的血液体积（BV5）、CT 肺气肿和胸肌面积。多变量线性和 Cox 回归模型用于探讨肺气肿、静脉 BV5、胸肌面积与 LV 之间的关系，以及 LV 与圣乔治呼吸问卷、6 分钟步行距离和全因死亡率之间的健康状况关系。结果 队列的中位年龄为 64 岁（四分位间距，57-70 岁）。在 2423 名参与者中，1806 名是男性，617 名是非洲裔美国人。在全球慢性阻塞性肺疾病倡议（GOLD）1 级和 GOLD 4 级 COPD 中，女性的 LV 降低了 13.9%，男性降低了 17.7%（均<0.001）。在完全调整的模型中，更高的肺气肿百分比（β=-4.2；95%置信区间[CI]：-5.0，-3.4；<0.001）、静脉 BV5（β=7.0；95%CI：5.7，8.2；<0.001）和胸肌面积（β=2.7；95%CI：1.2，4.1；<0.001）与 LV 减少独立相关。LV 的减少与健康状况的改善（β=0.3；95%CI：0.1，0.4）和 6 分钟步行距离（β=-12.2；95%CI：-15.2，-9.3）相关。这些影响在女性中比在男性中更大。LV 减少对死亡率的影响（危险比：1.07；95%CI：1.05，1.09）不因性别而异。结论 在 COPD 女性中，与 LV 心外膜容积减少相关的是肺静脉血管的丧失、更大的胸肌肌减少症和更低的全因死亡率，而在男性中则不然。
Zotero 插件