T1 Measurements for Detection of Expansion of the Myocardial Extracellular Volume in Chronic Obstructive Pulmonary Disease

Abstract

Background We aimed to assess whether chronic obstructive pulmonary disease (COPD) is associated with expansion of the myocardial extracellular volume (ECV) using T1 measurements. Methods Adult COPD patients (GOLD stage 2 or higher) and free of known cardiovascular disease were recruited. All study patients underwent measures of pulmonary function, 6-minute walk test, serum measures of inflammation, overnight polysomnography, and a contrast CMR study. Results Eight patients with COPD were compared to 8 healthy control subjects. The mean predicted FEV1% of COPD subjects was 68%. Compared to controls, patients had normal left ventricular (LV) and right ventricular size, mass, and function. However, as compared to controls, the LV remodeling index (median 0.87 IQR 0.43 vs. median 0.62 IQR 0.17, p=0.03) and active left atrial emptying fraction was increased (median 46 IQR 8 vs. median 38 IQR 10, p=0.005), and passive left atrial emptying fraction was reduced (median 24 IQR 10 vs. median 44 IQR 20, p=0.007). The ECV was increased in patients with COPD (median 0.32 IQR 0.05 vs. median 0.27 IQR 0.05, p=0.001). The ECV showed a strong positive association with LV remodeling (r = 0.72, p = 0.04) and an inverse association with the 6-minute walk duration (r = −0.79, p = 0.02) and passive left atrial emptying fraction (r = −0.68, p = 0.003). Conclusions Expansion of the ECV, suggestive of diffuse myocardial fibrosis, is present in COPD and is associated with LV remodeling, reduced left atrial function and exercise capacity.

Predictive factors for COPD exacerbations and mortality in patients with overlap syndrome

“…In line with other investigations, cardiovascular diseases account for the majority of all‐cause mortality in overlap syndrome . Existing evidence shows that deleterious cardiac changes are worse in those with overlap compared with COPD alone . Among these structural adaptations is the increased mass of the right ventricle which reflects hypoxic pulmonary vasoconstriction precipitated by an unrelenting destruction of the lung parenchyma.…”

“…Among these structural adaptations is the increased mass of the right ventricle which reflects hypoxic pulmonary vasoconstriction precipitated by an unrelenting destruction of the lung parenchyma. In addition, recent cardiac MRI imaging identified increased areas of myocardial fibrosis in people with COPD that correlated with the severity of hypoxemia . Because the amount of myocardial fibrosis plays a significant role in vulnerability to fatal arrhythmia, it is plausible that the degree of hypoxemia observed in overlap syndrome can only accentuate the extent of cardiac fibrosis resulting in sudden cardiac death.…”

Chest pain in patients with COPD: the fascia’s subtle silence

“…This could lead to a change in the movement and shape of the viscera themselves, an event that, as we know, can occur in the respiratory and cardiac systems in the presence of chronic pathologies of the airways. 68 , 69 An anomalous distention of the viscera could activate nociceptive pathways connected to the cerebellum through mossy and climbing fibers and diffuse monoaminergic and cholinergic afferents. 70 A-delta fibers and C-fibers, afferential nociceptive pathways, activate the previously mentioned nervous fibers through postsynaptic connections in the dorsal medullary area.…”

The overlaps of asthma or COPD with OSA: A focused review

“…adherence to statin therapy) that improve outcomes in this group of patients is not known. However, data are emerging that show deleterious cardiac changes worse in those with overlap compared with COPD alone, 54,55 and these changes are generally driven by the burden of hypoxaemia. One other important way that OSA could modify COPD is via alterations in breathing control.…”