Percent emphysema, airflow obstruction, and impaired left ventricular filling.
Percent emphysema, airflow obstruction, and impaired left ventricular filling.
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DOI：
10.1056/nejmoa0808836
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发表时间：
2010-01-21
期刊：
影响因子：
--
通讯作者：
Watson KE
中科院分区：
文献类型：
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作者：
Barr RG;Bluemke DA;Ahmed FS;Carr JJ;Enright PL;Hoffman EA;Jiang R;Kawut SM;Kronmal RA;Lima JA;Shahar E;Smith LJ;Watson KE
非常严重的慢性阻塞性肺疾病引起肺心病，肺动脉血管阻力升高，左心室充盈、卒中量和心输出量继发性减少。我们假设，在没有非常严重肺部疾病的人群中，通过计算机断层扫描（CT）检测到的肺气肿和气流阻塞与左心室舒张末期容积、卒中容积和心输出量呈负相关。我们用磁共振成像技术测量了2816名年龄在45岁到84岁之间的人的左心室结构和功能。肺气肿的范围（以肺气肿百分比表示）定义为心脏计算机断层扫描肺窗中低于- 910霍斯菲尔德单位的体素百分比。肺活量测定按照美国胸科学会指南进行。使用广义加性模型来检验阈值效应。在研究参与者中，13%的人现在吸烟，38%的人曾经吸烟，49%的人从不吸烟。肺气肿百分比增加10个百分点与左室舒张末期容积（- 4.1 ml， 95%可信区间[CI]， - 3.3至- 4.9，P<0.001）、卒中容积（- 2.7 ml, 95% CI, - 2.2至- 3.3，P<0.001）和心输出量（- 0.19升/分钟，95% CI, - 0.14至- 0.23，P<0.001）的减少呈线性相关。这些关联在当前吸烟者中比在曾经吸烟者和从未吸烟者中更为明显。气流阻塞的程度与左心室结构和功能相似，吸烟状况对这些关联具有相似的调节作用。肺气肿和气流阻塞的百分比与左心室射血分数无关。在一项基于人群的研究中，CT扫描肺气肿程度越大和气流阻塞程度越严重，与左心室充盈受损、卒中容量减少和心输出量降低呈线性相关，而射血分数没有变化。
Very severe chronic obstructive pulmonary disease causes cor pulmonale with elevated pulmonary vascular resistance and secondary reductions in left ventricular filling, stroke volume, and cardiac output. We hypothesized that emphysema, as detected on computed tomography (CT), and airflow obstruction are inversely related to left ventricular end-diastolic volume, stroke volume, and cardiac output among persons without very severe lung disease. We measured left ventricular structure and function with the use of magnetic resonance imaging in 2816 persons who were 45 to 84 years of age. The extent of emphysema (expressed as percent emphysema) was defined as the percentage of voxels below −910 Hounsfield units in the lung windows on cardiac computed tomographic scans. Spirometry was performed according to American Thoracic Society guidelines. Generalized additive models were used to test for threshold effects. Of the study participants, 13% were current smokers, 38% were former smokers, and 49% had never smoked. A 10-point increase in percent emphysema was linearly related to reductions in left ventricular end-diastolic volume (−4.1 ml; 95% confidence interval [CI], −3.3 to −4.9; P<0.001), stroke volume (−2.7 ml; 95% CI, −2.2 to −3.3; P<0.001), and cardiac output (−0.19 liters per minute; 95% CI, −0.14 to −0.23; P<0.001). These associations were of greater magnitude among current smokers than among former smokers and those who had never smoked. The extent of airflow obstruction was similarly associated with left ventricular structure and function, and smoking status had similar modifying effects on these associations. Percent emphysema and airflow obstruction were not associated with the left ventricular ejection fraction. In a population-based study, a greater extent of emphysema on CT scanning and more severe airflow obstruction were linearly related to impaired left ventricular filling, reduced stroke volume, and lower cardiac output without changes in the ejection fraction.