Mechanisms Underlying the Association of Chronic Obstructive Pulmonary Disease With Heart Failure

Jakub Lagan, Erik B. Schelbert, Josephine H. Naish, Jørgen Vestbo, Christien Fortune, Joshua Bradley, John Belcher, Edward Hearne, Foluwakemi Ogunyemi, Richard Timoney, Daniel Prescott, Hamish D.C. Bain, Tasneem Bangi, Mahvash Zaman, Christopher Wong, Anthony Ashworth, Helen Thorpe, Robin Egdell, Jerome McIntosh, Bruce R. IrwinDavid Clark, Graham Devereux, Jennifer K. Quint, Richard Barraclough, Matthias Schmitt, Christopher A. Miller

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

Objectives

The 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.

Background

COPD is associated with HF independent of shared risk factors. The underlying pathophysiological mechanism is unknown.

Methods

A 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.

Results

COPD 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.

Conclusions

The 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.

Original languageEnglish
Pages (from-to)1963-1973
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume14
Issue number10
Early online date19 May 2021
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • cardiac magnetic resonance
  • chronic obstructive pulmonary disease
  • heart failure
  • mortality
  • myocardial fibrosis
  • myocardial inflammation

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