Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study.
Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study.
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DOI：
10.1016/j.jacc.2014.07.991
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发表时间：
2014-11-11
影响因子：
24
通讯作者：
Barr, Graham
中科院分区：
文献类型：
--
作者：
Kawut, Steven M.;Poor, Hooman D.;Parikh, Megha A.;Hueper, Katja;Smith, Benjamin M.;Bluemke, David A.;Lima, Joao A. C.;Prince, Martin R.;Hoffman, Eric A.;Austin, John H. M.;Vogel-Claussen, Jens;Barr, Graham
慢性阻塞性肺疾病（COPD）的典型心血管并发症是肺心病，或右心室（RV）扩大。肺源性心脏病的大多数研究是在几十年前进行的。我们的目的是检查右心室的变化，在当代COPD和肺气肿使用心脏磁共振成像（MRI）。我们进行了一项病例对照研究，主要嵌套在两项一般人群研究中，纳入了310名年龄在50-79岁之间、吸烟≥ 10包-年且无临床心血管疾病的COPD受试者和对照者。使用MRI评估RV体积和质量。COPD和COPD严重程度由标准肺量测定标准定义。肺气肿百分比定义为全肺计算机断层扫描上<-950 Hounsfield单位的肺区域百分比;肺气肿亚型由放射科医生评分。结果根据年龄、种族/民族、性别、身高、体重、吸烟状况、包年、全身性高血压和睡眠呼吸暂停进行调整。与对照组相比，COPD患者的RV舒张末期容积降低（-7.8 mL，95% CI：-15.0，-0.5 mL; p=0.04）。COPD严重程度的增加与RV舒张末期容积较小（p=0.004）和RV每搏输出量较低（p<0.001）相关。两组的右心室质量和射血分数相似。肺气肿百分比越高，右室舒张末期容积（p=0.005）和每搏输出量（p<0.001）越小，小叶中心和隔旁肺气肿也是如此。在当代COPD（“肺心病”）中，RV体积较低，而RV质量和射血分数无显著变化，这种减少与计算机断层扫描显示的肺气肿百分比较高有关。
The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale, or enlargement of the right ventricle (RV). Most studies of cor pulmonale were conducted decades ago. We aimed to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance imaging (MRI). We performed a case-control study nested predominantly in two general population studies of 310 participants with COPD and controls ages 50–79 years with ≥ 10 pack-years of smoking and who were free of clinical cardiovascular disease. RV volumes and mass were assessed using MRI. COPD and COPD severity were defined by standard spirometric criteria. Percent emphysema was defined as percent 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. RV end-diastolic volume was reduced in COPD compared to controls (-7.8 mL, 95% CI: -15.0, -0.5 mL; p=0.04). Increasing severity of COPD was associated with smaller RV end-diastolic volume (p=0.004) and lower RV stroke volume (p<0.001). RV mass and ejection fraction were similar between the groups. Greater percent emphysema was also associated with smaller RV end-diastolic volume (p=0.005) and stroke volume (p<0.001), as was the presence of centrilobular and paraseptal emphysema. RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD (“cor pulmonale parvus”) and this reduction is related to greater percent emphysema on computed tomography.
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DOI：
10.1164/ajrccm.164.2.2006129
发表时间：
2001-07-15
影响因子：
24.7
作者：
Kessler, R;Faller, M;Oswald-Mammosser, M
通讯作者：
Oswald-Mammosser, M
影响因子：
9.6
作者：
Hankinson, John L.;Kawut, Steven M.;Barr, R. Graham
通讯作者：
Barr, R. Graham
影响因子：
2.8
作者：
Chahal, Harjit;Johnson, Craig;Bluemke, David A.
通讯作者：
Bluemke, David A.
影响因子：
4.4
作者：
Marcus, JT;Noordegraaf, AV;Postmus, PE
通讯作者：
Postmus, PE
影响因子：
6.7
作者：
Hueper, Katja;Parikh, Megha A.;Vogel-Claussen, Jens
通讯作者：
Vogel-Claussen, Jens