. 2020 Feb;157(2):258-267.

doi: 10.1016/j.chest.2019.08.2185. Epub 2019 Sep 12.

Estimated Ventricular Size, Asthma Severity, and Exacerbations: The Severe Asthma Research Program III Cohort

Samuel Y Ash¹, Gonzalo Vegas Sanchez-Ferrero², Mark L Schiebler³, Farbod N Rahaghi⁴, Ashish Rai⁵, Carolyn E Come⁴, James C Ross², Alysha G Colon⁶, Juan Carlos Cardet⁷, Eugene R Bleecker⁸, Mario Castro⁹, John V Fahy¹⁰, Sean B Fain¹¹, Benjamin M Gaston¹², Eric A Hoffman¹³, Nizar N Jarjour¹⁴, Jason K Lempel¹⁵, David T Mauger¹⁶, Matthew C Tattersall¹⁷, Sally E Wenzel¹⁸, Bruce D Levy¹⁹, George R Washko⁴, Elliot Israel¹⁹, Raul San Jose Estepar²; SARP Investigators

Collaborators, Affiliations

Collaborators

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA. Electronic address: syash@bwh.harvard.edu.
² Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
³ Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁴ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
⁵ Department of Medicine, North Shore Medical Center, Salem, MA.
⁶ College of Medicine, University of Florida, Gainesville, FL.
⁷ Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, FL.
⁸ Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, AZ.
⁹ Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO.
¹⁰ Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA.
¹¹ Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI.
¹² Division of Pulmonology, Allergy, and Immunology, and Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, OH.
¹³ Departments of Radiology, Biomedical Engineering, and Medicine, University of Iowa, Iowa City, IA.
¹⁴ Division of Pulmonary and Critical Care Medicine (Dr Jarjour), University of Wisconsin School of Medicine and Public Health, Madison, WI.
¹⁵ Department of Radiology, Cleveland Clinic, Cleveland, OH.
¹⁶ Division of Biostatistics and Bioinformatics, Penn State Eberly College of Science, University Park, PA.
¹⁷ Division of Cardiovascular Medicine (Dr Tattersall), University of Wisconsin School of Medicine and Public Health, Madison, WI.
¹⁸ Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA.
¹⁹ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA.

PMID: 31521672
PMCID: PMC7005378
DOI: 10.1016/j.chest.2019.08.2185

Estimated Ventricular Size, Asthma Severity, and Exacerbations: The Severe Asthma Research Program III Cohort

Samuel Y Ash et al. Chest. 2020 Feb.

. 2020 Feb;157(2):258-267.

doi: 10.1016/j.chest.2019.08.2185. Epub 2019 Sep 12.

Authors

Collaborators

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA. Electronic address: syash@bwh.harvard.edu.
² Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
³ Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁴ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
⁵ Department of Medicine, North Shore Medical Center, Salem, MA.
⁶ College of Medicine, University of Florida, Gainesville, FL.
⁷ Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, FL.
⁸ Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, AZ.
⁹ Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO.
¹⁰ Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA.
¹¹ Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI.
¹² Division of Pulmonology, Allergy, and Immunology, and Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, OH.
¹³ Departments of Radiology, Biomedical Engineering, and Medicine, University of Iowa, Iowa City, IA.
¹⁴ Division of Pulmonary and Critical Care Medicine (Dr Jarjour), University of Wisconsin School of Medicine and Public Health, Madison, WI.
¹⁵ Department of Radiology, Cleveland Clinic, Cleveland, OH.
¹⁶ Division of Biostatistics and Bioinformatics, Penn State Eberly College of Science, University Park, PA.
¹⁷ Division of Cardiovascular Medicine (Dr Tattersall), University of Wisconsin School of Medicine and Public Health, Madison, WI.
¹⁸ Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA.
¹⁹ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA.

PMID: 31521672
PMCID: PMC7005378
DOI: 10.1016/j.chest.2019.08.2185

Abstract

Background: Relative enlargement of the pulmonary artery (PA) on chest CT imaging is associated with respiratory exacerbations in patients with COPD or cystic fibrosis. We sought to determine whether similar findings were present in patients with asthma and whether these findings were explained by differences in ventricular size.

Methods: We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left, and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI, and eETVVI, respectively). Associations between the cardiac and PA measures (PA-to-aorta [PA/A] ratio, eERVVI-to-eELVVI [eRV/eLV] ratio, eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed by Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated by multivariable linear and zero-inflated negative binomial regression.

Results: Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m² smaller eETVVI than healthy control subjects (P = .003) and 14.1 mL/m² smaller eETVVI than those with mild/moderate disease (P = .011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example, those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow-up than those with eETVVI greater than the median (P = .020). Neither PA/A nor eRV/eLV was associated with asthma severity or exacerbations.

Conclusions: In patients with asthma, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations.

Trial registry: ClinicalTrials.gov; No.: NCT01761630; URL: www.clinicaltrials.gov.

Keywords: CT imaging; asthma; heart.

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Figures

**Figure 1**
CONSORT diagram. CONSORT = Consolidated Standards of Reporting Trials.

**Figure 2**
Sample cardiac segmentation images. Sample heart segmentation images from participants with mild/moderate asthma (A; cardiac volume, 362.8 mL) and severe asthma (B; cardiac ventricular volume, 152.6 mL). The red surface represents the epicardial surface of the left ventricle, and the blue surface represents the epicardial surface of the right ventricle. Note that the images are shown to scale.

See this image and copyright information in PMC

Comment in

Estimated Ventricular Size: A New Predictor of Asthma Severity and Exacerbation Rate?
Barry JR, Akuthota P. Barry JR, et al. Chest. 2020 Feb;157(2):243-244. doi: 10.1016/j.chest.2019.10.019. Chest. 2020. PMID: 32033641 No abstract available.

Cited by

The emerging role of quantitative imaging in asthma.
Krings JG, Wenzel SE, Castro M. Krings JG, et al. Br J Radiol. 2022 Apr 1;95(1132):20201133. doi: 10.1259/bjr.20201133. Epub 2020 Dec 3. Br J Radiol. 2022. PMID: 33242252 Free PMC article.

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Estimated Ventricular Size, Asthma Severity, and Exacerbations: The Severe Asthma Research Program III Cohort

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