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. 2014 Nov 11;64(19):2000-9.
doi: 10.1016/j.jacc.2014.07.991. Epub 2014 Nov 3.

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

Steven M Kawut  1 , Hooman D Poor  2 , Megha A Parikh  2 , Katja Hueper  3 , Benjamin M Smith  2 , David A Bluemke  4 , João A C Lima  5 , Martin R Prince  6 , Eric A Hoffman  7 , John H M Austin  6 , Jens Vogel-Claussen  3 , R Graham Barr  8
Affiliations

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

Steven M Kawut et al. J Am Coll Cardiol. .

Abstract

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.

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. 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.

Keywords: end-diastolic volume; heart failure; pulmonary hypertension; right ventricle.

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Figures

Figure 1
Figure 1. Multivariate Relationships between the Ratio of the Forced Expiratory Volume in One Second to Forced Vital Capacity and Right Ventricular End-Diastolic Volume and Mass
Smoothed regression plot of the relationship (solid line) of the ratio of the forced expiratory volume in one second to forced vital capacity with right ventricular end-diastolic volume (Panel A) and mass (Panel B) and 95% confidence intervals (dashed lines). The plots were obtained from regression models adjusted for age, sex, race/ethnicity, cohort, height, weight, smoking status, pack-years, hypertension, and sleep apnea. The hash marks denote data points.
Figure 2
Figure 2. Multivariate Relationships between Percent Emphysema and Right Ventricular End-Diastolic Volume and Mass
Smoothed regression plot of the relationship (solid line) of percent emphysema with right ventricular end-diastolic volume (Panel A) and mass (Panel B) and 95% confidence intervals (dashed lines). The plots were obtained from regression models adjusted for age, sex, race/ethnicity, cohort, height, weight, smoking status, pack-years, hypertension, sleep apnea and mAs. The hash marks denote data points.
See this image and copyright information in PMC

Comment in

  • Cor pulmonale parvus: patting the elephant.
    Reichek N. Reichek N. J Am Coll Cardiol. 2014 Nov 11;64(19):2010-2. doi: 10.1016/j.jacc.2014.09.006. Epub 2014 Nov 3. J Am Coll Cardiol. 2014. PMID: 25440096 No abstract available.

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