Left Ventricular Performance and Dimensions in Patients with Severe Emphysema

Jörgensen, Kirsten; Houltz, Erik; Westfelt, U. Nathorst; Ricksten, Sven‐Erik

doi:10.1213/01.ane.0000258020.27849.6b

Cited by 17 publications

(11 citation statements)

References 31 publications

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“…[38][39][40] Alternatively, hyperinfl ation-associated increase in intrathoracic pressure may act directly at the LV to impair fi lling. However, we believe this mechanism unlikely because upstream intrathoracic structures would also be exposed to this augmented pressure.…”

Section: Discussionmentioning

confidence: 99%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

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1143C hronic lower respiratory disease is the third-leading cause of death in the United States. 1 The most morbid components of chronic lower respiratory dis ease are COPD, defi ned by spirometry as airfl ow obstruction that is not fully reversible, and pulmonary emphysema, defi ned by morphology as permanent enlargement of airspaces accompanied by destruction of their walls. 2,3 Emphysema on CT imaging is present in approximately one-half of patients with COPD, 4-7 and an estimated 2% of the general population aged . 50 years has emphysema without spirometry-defi ned COPD. 8 The number of Americans with a diagnosis of heart failure was 5.7 million in 2008, and approximately one-half of prevalent heart failure cases are characterized by preserved ejection fraction. 9,10 By comparison, 12 million Americans have a diagnosis of COPD and an additional 12 million may have undiagnosed COPD and emphysema. 11Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) fi lling 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 defi ned by spirometry. Percent emphysema was defi ned as regions , 2 910 Hounsfi eld 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 ( Ϯ SD) total pulmonary vein area was 558 Ϯ 159 mm 2 in patients with COPD and 623 Ϯ 145 mm 2 in control subjects. Total pulmonary vein area was smaller in patients with COPD ( 2 57 mm 2 ; 95% CI, 2 106 to 2 7 mm 2 ; P 5 .03) and inversely associated with percent emphysema ( P , .001) in fully adjusted models. Signifi cant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defi ned COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These fi ndings support a mechanism of upstream pulmonary causes of underfi lling of the LV in COPD and in patients with emphysema on CT scan. CHEST 2013; 144(4):1143-1151Abbreviations: E/A ratio 5 ratio of peak fi lling rates during early phase diastole and atrial contraction; E/A ratioMR 5 ratio of peak fi lling rates during early phase diastole and atrial contraction estimated by magnetic resonance; EDV 5 end-diastolic volume; LV 5 left ventricle; MESA 5 Multi-Ethnic Study of Atherosclero...

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Section: Discussionmentioning

confidence: 99%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

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“…Ten years ago, Jörgensen et al [43][44][45] hypothesized that hyperinflated lungs and high intrinsic positive end-expiratory pressure will decrease intrathoracic blood volume and ventricular preload, resulting in "hypovolemic diastole". Ten years ago, Jörgensen et al [43][44][45] hypothesized that hyperinflated lungs and high intrinsic positive end-expiratory pressure will decrease intrathoracic blood volume and ventricular preload, resulting in "hypovolemic diastole".…”

Section: Hyperinflation and Emphysemamentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Left Ventricle

Portillo

Abad‐Capa

Ruiz-Manzano

2015

Archivos de Bronconeumología (English Edition)

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“…Twenty-one studies that evaluated the hemodynamic effects of PLR 1 [5,6,12,14,15,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] were included. In total, 431 subjects were studied, with an average of 14 patients per study.…”

Section: Passive Leg Raisingmentioning

confidence: 99%

Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia?

Geerts¹,

Bergh²,

Stijnen³

et al. 2012

Journal of Clinical Anesthesia

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Left Ventricular Performance and Dimensions in Patients with Severe Emphysema

Abstract: The LV in patients with severe emphysema is hypovolemic, and operates on a steeper portion of the LV function curve, while indices of systolic function are not significantly impaired compared to non-emphysematous controls.

Cited by 17 publications

References 31 publications

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Chronic Obstructive Pulmonary Disease and Left Ventricle

Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia?

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