Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: The MESA COPD study

Steven M. Kawut, Hooman D. Poor, Megha A. Parikh, Katja Hueper, Benjamin M. Smith, David A. Bluemke, João A.C. Lima, Martin R. Prince, Eric A. Hoffman, John H.M. Austin, Jens Vogel-Claussen, R. Graham Barr

Research output: Contribution to journalArticlepeer-review

62 Scopus citations

Abstract

Methods We performed a case-control study nested predominantly in 2 general population studies of 310 participants with COPD and control subjects 50 to 79 years of age with ≤10 pack-years of smoking who were free of clinical cardiovascular disease. RV volumes and mass were assessed using magnetic resonance imaging. COPD and COPD severity were defined according to standard spirometric criteria. The percentage of emphysema was defined as the percentage of lung regions <-950 Hounsfield units on full-lung computed tomography; emphysema subtypes were scored by radiologists.

Background The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale or right ventricular (RV) enlargement. Most studies of cor pulmonale were conducted decades ago.

Objectives This study sought to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance (CMR) imaging.

Results were adjusted for age, race/ethnicity, sex, height, weight, smoking status, pack-years, systemic hypertension, and sleep apnea. Results Right ventricular end-diastolic volume (RVEDV) was reduced in COPD compared with control subjects (-7.8 ml; 95% confidence interval: -15.0 to -0.5 ml; p = 0.04). Increasing severity of COPD was associated with lower RVEDV (p = 0.004) and lower RV stroke volume (p < 0.001). RV mass and ejection fraction were similar between the groups. A greater percentage of emphysema also was associated with lower RVEDV (p = 0.005) and stroke volume (p < 0.001), as was the presence of centrilobular and paraseptal emphysema.

Conclusions RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD, and this reduction is related to the greater percentage of emphysema on computed tomography.

Original languageEnglish
Pages (from-to)2000-2009
Number of pages10
JournalJournal of the American College of Cardiology
Volume64
Issue number19
DOIs
StatePublished - 11 Nov 2014
Externally publishedYes

Keywords

  • end-diastolic volume
  • heart failure
  • pulmonary hypertension
  • right ventricle

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