TY - JOUR
T1 - Mechanisms Underlying the Association of Chronic Obstructive Pulmonary Disease With Heart Failure
AU - Lagan, Jakub
AU - Schelbert, Erik B.
AU - Naish, Josephine H.
AU - Vestbo, Jørgen
AU - Fortune, Christien
AU - Bradley, Joshua
AU - Belcher, John
AU - Hearne, Edward
AU - Ogunyemi, Foluwakemi
AU - Timoney, Richard
AU - Prescott, Daniel
AU - Bain, Hamish D.C.
AU - Bangi, Tasneem
AU - Zaman, Mahvash
AU - Wong, Christopher
AU - Ashworth, Anthony
AU - Thorpe, Helen
AU - Egdell, Robin
AU - McIntosh, Jerome
AU - Irwin, Bruce R.
AU - Clark, David
AU - Devereux, Graham
AU - Quint, Jennifer K.
AU - Barraclough, Richard
AU - Schmitt, Matthias
AU - Miller, Christopher A.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - ObjectivesThe purposes of this study were to determine why chronic obstructive pulmonary disease (COPD) is associated with heart failure (HF). Specific objectives included whether COPD is associated with myocardial fibrosis, whether myocardial fibrosis is associated with hospitalization for HF and death in COPD, and whether COPD and smoking are associated with myocardial inflammation. BackgroundCOPD is associated with HF independent of shared risk factors. The underlying pathophysiological mechanism is unknown. MethodsA prospective, multicenter, longitudinal cohort study of 572 patients undergoing cardiac magnetic resonance (CMR), including 450 patients with COPD and 122 age- and sex-matched patients with a median: 726 days (interquartile range: 492 to 1,160 days) follow-up. Multivariate analysis was used to examine the relationship between COPD and myocardial fibrosis, measured using cardiac magnetic resonance (CMR). Cox regression analysis was used to examine the relationship between myocardial fibrosis and outcomes; the primary endpoint was composite of hospitalizations for HF or all-cause mortality; secondary endpoints included hospitalizations for HF and all-cause mortality. Fifteen patients with COPD, 15 current smokers, and 15 healthy volunteers underwent evaluation for myocardial inflammation, including ultrasmall superparamagnetic particles of iron oxide CMR. ResultsCOPD was independently associated with myocardial fibrosis (p < 0.001). Myocardial fibrosis was independently associated with the primary outcome (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.08 to 1.20; p < 0.001), hospitalization for HF (HR: 1.25 [95% CI: 1.14 to 1.36]); p < 0.001), and all-cause mortality. Myocardial fibrosis was associated with outcome measurements more strongly than any other variable. Acute and stable COPD were associated with myocardial inflammation. ConclusionsThe associations between COPD, myocardial inflammation and myocardial fibrosis, and the independent prognostic value of myocardial fibrosis elucidate a potential pathophysiological link between COPD and HF.
AB - ObjectivesThe purposes of this study were to determine why chronic obstructive pulmonary disease (COPD) is associated with heart failure (HF). Specific objectives included whether COPD is associated with myocardial fibrosis, whether myocardial fibrosis is associated with hospitalization for HF and death in COPD, and whether COPD and smoking are associated with myocardial inflammation. BackgroundCOPD is associated with HF independent of shared risk factors. The underlying pathophysiological mechanism is unknown. MethodsA prospective, multicenter, longitudinal cohort study of 572 patients undergoing cardiac magnetic resonance (CMR), including 450 patients with COPD and 122 age- and sex-matched patients with a median: 726 days (interquartile range: 492 to 1,160 days) follow-up. Multivariate analysis was used to examine the relationship between COPD and myocardial fibrosis, measured using cardiac magnetic resonance (CMR). Cox regression analysis was used to examine the relationship between myocardial fibrosis and outcomes; the primary endpoint was composite of hospitalizations for HF or all-cause mortality; secondary endpoints included hospitalizations for HF and all-cause mortality. Fifteen patients with COPD, 15 current smokers, and 15 healthy volunteers underwent evaluation for myocardial inflammation, including ultrasmall superparamagnetic particles of iron oxide CMR. ResultsCOPD was independently associated with myocardial fibrosis (p < 0.001). Myocardial fibrosis was independently associated with the primary outcome (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.08 to 1.20; p < 0.001), hospitalization for HF (HR: 1.25 [95% CI: 1.14 to 1.36]); p < 0.001), and all-cause mortality. Myocardial fibrosis was associated with outcome measurements more strongly than any other variable. Acute and stable COPD were associated with myocardial inflammation. ConclusionsThe associations between COPD, myocardial inflammation and myocardial fibrosis, and the independent prognostic value of myocardial fibrosis elucidate a potential pathophysiological link between COPD and HF.
KW - cardiac magnetic resonance
KW - chronic obstructive pulmonary disease
KW - heart failure
KW - mortality
KW - myocardial fibrosis
KW - myocardial inflammation
U2 - 10.1016/j.jcmg.2021.03.026
DO - 10.1016/j.jcmg.2021.03.026
M3 - Article
SN - 1936-878X
VL - 14
SP - 1963
EP - 1973
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 10
ER -