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Severity of emphysema linked with left ventricular filling, cardiac output impairment
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A greater extent of emphysema and severity of airflow obstruction in patients with chronic obstructive pulmonary disease was associated with changes in stroke volume, left ventricular filling and cardiac output, study results indicated.
As part of the MESA Lung Study researchers enrolled 2,816 participants with chronic obstructive pulmonary disease whose left ventricular structure and function were previously assessed using cardiac magnetic resonance imaging, and whose emphysema was assessed using CT. Participants also underwent spirometry between 2004 and 2006. All participants were aged 45 to 84; 13% were current smokers; 38% were former smokers and 49% had never smoked.
An increase of 10 percentage points in percent emphysema was associated with a 4.1-mL decrement in LV end-diastolic volume (P<.001), a 1.4-mL decrement in LV end-systolic volume (P<.001), a 2.7-mL decrement in stroke volume (P<.001)and a 0.19-L per minute decrement in cardiac output (P<.001), data indicated.
“The apparent effect of emphysema on LV end-diastolic volume and cardiac output was similar to that of traditional cardiac risk factors previously reported in MESA and, among smokers, was greater than that of traditional cardiac risk factors,” the researchers wrote.
There was no association between percent emphysema and LV ejection fraction, the researchers reported.
“[I]n this population-based study of subjects without very severe chronic obstructive pulmonary disease, percent emphysema and the severity of airflow obstruction were associated with significant decrements in LV filling and cardiac output,” the researchers wrote.
Barr R. N Engl J Med. 2010;362:217-227.