title: Pulmonary function and adverse cardiovascular outcomes: Can cardiac function explain the link?
abstract: The complex interaction between pulmonary function, cardiac function and adverse cardiovascular events has only been partially described. We sought to describe the association between pulmonary function with left heart structure and function, all-cause mortality and incident cardiovascular hospitalization.
  
  
  
  This study is a retrospective analysis of patients evaluated in a single tertiary care medical center. We used multivariable linear regression analyses to examine the relationship between FVC and FEV1 with left ventricular ejection fraction (LVEF), left ventricular internal dimension in systole and diastole (LVIDS, LVIDD) and left atrial diameter, adjusting for baseline characteristics, right ventricular function and lung hyperinflation. We also used Cox proportional hazards models to examine the relationship between FVC and FEV1 with all-cause mortality and cardiac hospitalization.
  
  
  
  A total of 1807 patients were included in this analysis with a median age of 61 years and 50% were female. Decreased FVC and FEV1 were both associated with decreased LVEF. In individuals with FVC less than 2.75 L, decreased FVC was associated with increased all-cause mortality after adjusting for left and right heart echocardiographic variables (hazard ratio [HR] 0.49, 95% CI 0.29, 0.82, respectively). Decreased FVC was associated with increased cardiac hospitalization after adjusting for left heart size (HR 0.80, 95% CI 0.67, 0.96), even in patients with normal LVEF (HR 0.75, 95% CI 0.57, 0.97).
  
  
  
  In a tertiary care center reduced pulmonary function was associated with adverse cardiovascular events, a relationship that is not fully explained by left heart remodeling or right heart dysfunction.
authors.affiliation: Division of Cardiology, Department of Medicine, University of California, San Francisco, United States. Electronic address: melissa.burroughspena@ucsf.edu.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Burroughs Peña
authors.affiliation: Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University, United States.
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University, United States; Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Durheim
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Kussin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, United States.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.affiliation: Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University, United States.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology; D014797:Vital Capacity / Q000502:physiology
keywords: Cardiovascular disease; Echocardiography; Pulmonary function; Spirometry