title: Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study.
abstract: BACKGROUND
  The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale or right ventricular (RV) enlargement. Most studies of cor pulmonale were conducted decades ago.
  
  
  OBJECTIVE
  This study sought to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance (CMR) imaging.
  
  
  METHODS
  We performed a case-control study nested predominantly in 2 general population studies of 310 participants with COPD and control subjects 50 to 79 years of age with ≥10 pack-years of smoking who were free of clinical cardiovascular disease. RV volumes and mass were assessed using magnetic resonance imaging. COPD and COPD severity were defined according to standard spirometric criteria. The percentage of emphysema was defined as the percentage of lung regions <-950 Hounsfield units on full-lung computed tomography; emphysema subtypes were scored by radiologists. Results were adjusted for age, race/ethnicity, sex, height, weight, smoking status, pack-years, systemic hypertension, and sleep apnea.
  
  
  RESULTS
  Right ventricular end-diastolic volume (RVEDV) was reduced in COPD compared with control subjects (-7.8 ml; 95% confidence interval: -15.0 to -0.5 ml; p = 0.04). Increasing severity of COPD was associated with lower RVEDV (p = 0.004) and lower RV stroke volume (p < 0.001). RV mass and ejection fraction were similar between the groups. A greater percentage of emphysema also was associated with lower RVEDV (p = 0.005) and stroke volume (p < 0.001), as was the presence of centrilobular and paraseptal emphysema.
  
  
  CONCLUSIONS
  RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD, and this reduction is related to the greater percentage of emphysema on computed tomography.
authors.affiliation: Departments of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Hooman D
authors.initials: HD
authors.lastname: Poor
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Megha A
authors.initials: MA
authors.lastname: Parikh
authors.affiliation: Department of Radiology, Hannover Medical School, Hannover, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Hueper
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Smith
authors.affiliation: Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Departments of Medicine and Radiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Prince
authors.affiliation: Department of Radiology, University of Iowa, Iowa City, Iowa.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Hoffman
authors.affiliation: Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: John H M
authors.initials: JH
authors.lastname: Austin
authors.affiliation: Department of Radiology, Hannover Medical School, Hannover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Vogel-Claussen
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. Electronic address: rgb9@columbia.edu.
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003971:Diastole; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D011656:Pulmonary Emphysema / Q000150:complications*; D011660:Pulmonary Heart Disease / Q000150:complications*; D012891:Sleep Apnea Syndromes / Q000150:complications; D012907:Smoking / Q000009:adverse effects; D013147:Spirometry; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed; D016278:Ventricular Function, Right
keywords: end-diastolic volume; heart failure; pulmonary hypertension; right ventricle