title: Impaired left ventricular filling in COPD and emphysema: is it the heart or the lungs? The Multi-Ethnic Study of Atherosclerosis COPD Study.
abstract: BACKGROUND
  COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload.
  
  
  METHODS
  The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions &lt; -910 Hounsfield units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking.
  
  
  RESULTS
  Among 165 participants, the mean (± SD) total pulmonary vein area was 558 ± 159 mm2 in patients with COPD and 623 ± 145 mm2 in control subjects. Total pulmonary vein area was smaller in patients with COPD (-57 mm2; 95% CI, -106 to -7 mm2; P = .03) and inversely associated with percent emphysema (P &lt; .001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defined COPD.
  
  
  CONCLUSIONS
  Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Smith
authors.affiliation: Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Prince
authors.affiliation: Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Hoffman
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, MD.
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Statistics, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Dan
authors.initials: D
authors.lastname: Rabinowitz
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Katja
authors.initials: K
authors.lastname: Hueper
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Megha A
authors.initials: MA
authors.lastname: Parikh
authors.affiliation: David Geffen UCLA School of Medicine, Los Angeles, CA.
authors.forename: Antoinette S
authors.initials: AS
authors.lastname: Gomes
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: João A C
authors.initials: JAC
authors.lastname: Lima
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Electronic address: rgb9@columbia.edu.
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
mesh_terms: D000368:Aged; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000150:complications* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000209:etiology*