title: Myocardial perfusion reserve is impaired in patients with chronic obstructive pulmonary disease: a comparison to current smokers.
abstract: OBJECTIVE
  Recent studies have demonstrated that chronic obstructive pulmonary disease (COPD) is associated with cardiovascular disease (CVD). However, the association between COPD and coronary microcirculatory dysfunction is unknown. We sought to assess whether myocardial perfusion reserve (MPR) is impaired in patients with COPD, even in the absence of regional myocardial ischaemia or infarction, by using quantitative myocardial perfusion cardiovascular magnetic resonance (CMR).
  
  
  RESULTS
  We recruited 60 subjects with a normal CMR study: 20 individuals with mild-to-moderate COPD; 20 age-matched control smokers, and 20 age-matched control-never smokers. Individuals with established CVD and diabetes mellitus were excluded. Stress-rest myocardial blood flow (MBF) was quantified in 16 myocardial segments by using a Patlak plot method. There were no significant differences in the rest MBF among COPD patients, control smokers, and control-never smokers. However, the mean MPR was significantly lower in COPD patients than in control smokers and control-never smokers (1.76 ± 0.58, 2.57 ± 1.30, and 3.56 ± 1.27, respectively). Univariate associations with MPR were smoking (r = -0.44, P < 0.001), forced expiratory volume in 1 s (FEV1) (r = 0.30, P = 0.02), haematocrit (r = 0.25, P = 0.04), and C-reactive protein (CRP; r = -0.46, P < 0.001). On multivariable analysis, the levels of CRP, FEV1, and renal dysfunction were independent predictors of the impaired MPR. The presence of COPD was associated with a five-fold increased risk of MPR <1.5 (95% confidence interval, 1.4-19.0; P = 0.01).
  
  
  CONCLUSIONS
  The MPR, which was independently associated with systemic inflammation and airflow limitation, was impaired in patients with COPD. The presence of COPD was a powerful predictor of impaired MPR in patients without regional myocardial ischaemia or infarction.
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamori
authors.forename: Katsuya
authors.initials: K
authors.lastname: Onishi
authors.forename: Masaki
authors.initials: M
authors.lastname: Ishida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yamada
authors.forename: Motonori
authors.initials: M
authors.lastname: Nagata
authors.forename: Kakuya
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.forename: Mashio
authors.initials: M
authors.lastname: Nakamura
authors.forename: Hajime
authors.initials: H
authors.lastname: Sakuma
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D003287:Contrast Media; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology*; D013147:Spirometry
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: C-reactive protein; cardiovascular magnetic resonance; chronic obstructive pulmonary disease; myocardial perfusion reserve