Advanced Cardiovascular Imaging Laboratory, National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, ML, USA.
Department of Radiology, Columbia University, New York, USA.
Int J Cardiol. 2021 May 15;331:214-220. doi: 10.1016/j.ijcard.2021.02.017. Epub 2021 Feb 13.
The prevalence of abdominal aortic aneurysm is high in chronic obstructive pulmonary disease (COPD) population. Emphysema involves proteolytic destruction of elastic fibers. Therefore, emphysema may also contribute to thoracic aorta dilatation. This study assessed aorta dilation in smokers stratified by presence of COPD, emphysema and airway thickening.
Aorta diameters were measured on 3D magnetic resonance angiography in smokers recruited from the Multi-Ethnic Study of Atherosclerosis (MESA), the Emphysema and Cancer Action Project (EMCAP), and the local community. COPD was defined by standard spirometric criteria; emphysema was measured quantitatively on computed tomography and bronchitis was determined from medical history.
Participants (n = 315, age 58-79) included 150 with COPD and 165 without COPD, of whom 56% and 19%, respectively, had emphysema. Subjects in the most severe quartile of emphysematous change showed the largest diameter at all four aorta locations compared to those in the least severe quartiles (all p < 0.001). Comparing subjects with and without COPD, aorta diameters were larger in participants with severe COPD in ascending and arch (both p < 0.001), and abdominal aorta (p = 0.001). Chronic bronchitis and bronchial wall thickness did not correlate with aorta diameter. In subjects with emphysema, subjects with coexistence of COPD showed larger aorta than those without COPD in ascending (p = 0.003), arch (p = 0.002), and abdominal aorta (p = 0.04).
This study showed larger aorta diameter in subjects with COPD and severe emphysema compared to COPD related to chronic bronchitis or bronchial wall thickening.
慢性阻塞性肺疾病（COPD）患者的腹主动脉瘤患病率较高。肺气肿涉及弹性纤维的蛋白水解破坏。因此，肺气肿也可能导致胸主动脉扩张。本研究评估了在吸烟者中，根据 COPD、肺气肿和气道增厚的存在情况，主动脉扩张的情况。
在从动脉粥样硬化多民族研究（MESA）、肺气肿和癌症行动项目（EMCAP）以及当地社区招募的吸烟者中，通过 3D 磁共振血管造影测量主动脉直径。COPD 按照标准的肺活量标准定义；肺气肿通过计算机断层扫描进行定量测量，支气管炎通过病史确定。
参与者（n=315，年龄 58-79 岁）包括 150 例 COPD 患者和 165 例非 COPD 患者，其中分别有 56%和 19%患有肺气肿。在所有四个主动脉位置，与最严重四分位数的肺气肿变化相比，肺气肿变化最严重四分位数的患者显示出最大的直径（均 p<0.001）。与无 COPD 患者相比，严重 COPD 患者的升主动脉和弓部（均 p<0.001）以及腹主动脉的主动脉直径较大（p=0.001）。慢性支气管炎和支气管壁厚度与主动脉直径不相关。在患有肺气肿的患者中，与不伴 COPD 的患者相比，同时患有 COPD 的患者的升主动脉（p=0.003）、弓部（p=0.002）和腹主动脉（p=0.04）的主动脉直径较大。
与 COPD 相关的慢性支气管炎或支气管壁增厚相比，本研究显示 COPD 患者和严重肺气肿患者的主动脉直径较大。
