Associating the Severity of Emphysema with Coronary Flow Reserve and Left Atrial Conduit Function for the Emphysema Patients with Known or Suspected Coronary Artery Disease

Overview

Journal Magn Reson Med Sci

Specialty Radiology

Date 2022 Dec 14

PMID 36517009

Authors

Makiko Kubooka

Masaki Ishida

Masafumi Takafuji

Haruno Ito

Takanori Kokawa

Satoshi Nakamura

Kensuke Domae

Suguru Araki

Yasutaka Ichikawa

Shuichi Murashima

Hajime Sakuma

Affiliations

Soon will be listed here.

Abstract

Purpose: Pulmonary emphysema may associate with ischemic heart disease through systemic microvascular abnormality as a common pathway. Stress cardiovascular MR (CMR) allows for the assessment of global coronary flow reserve (CFR). The purpose of this study was to evaluate the association between the emphysema severity and the multiple MRI parameters in the emphysema patients with known or suspected coronary artery disease (CAD).

Methods: A total of 210 patients with known or suspected CAD who underwent both 3.0T CMR including cine CMR, stress and rest perfusion CMR, stress and rest phase-contrast (PC) cine CMR of coronary sinus, and late gadolinium enhancement (LGE) CMR, and lung CT within 6 months were studied. Global CFR, volumes and functions of both ventricles and atria, and presence or absence of myocardial ischemia and infarction were evaluated. Emphysema severity was visually determined on lung CT by Goddard method.

Result: Seventy nine (71.0 ± 7.9 years, 75 male) of 210 patients with known or suspected CAD had emphysema on lung CT. Goddard score was significantly correlated with CFR (r = -0.246, P = 0.029), left ventricular end-diastolic volume index (LV EDVI) (r = -0.230, P = 0.041), right ventricular systolic volume index (RV SVI) (r = -0.280, P = 0.012), left atrial (LA) total emptying volume index (r = -0.269, P = 0.017), LA passive emptying volume index (r = -0.309, P = 0.006), LA systolic strain (Es) (r = -0.244, P = 0.030), and LA conduit strain (Ee) (r = -0.285, P = 0.011) in the patients with emphysema. Multiple linear regression analysis revealed LA conduit function was independently associated with emphysema severity as determined by Goddard method (beta = -0.361, P = 0.006).

Conclusion: LA conduit function independently associates with emphysema severity in the emphysema patients with known or suspected CAD after adjusting age, sex, smoking, and the CMR indexes including CFR. These findings suggest that impairment of LA function predominantly occurs prior to the reduction of the CFR in the emphysema patients with known or suspected CAD.

Citing Articles

Microvascular Dysfunction in Patients with Idiopathic Dilated Cardiomyopathy: Quantitative Assessment with Phase Contrast Cine MR Imaging of the Coronary Sinus.

Takafuji M, Ishida M, Nakamura S, Nakata K, Ito H, Kokawa T Magn Reson Med Sci. 2023; 24(1):10-19.

PMID: 37766549 PMC: 11733506. DOI: 10.2463/mrms.mp.2023-0018.

References

Jain S, Kuriakose D, Edelstein I, Ansari B, Oldland G, Gaddam S . Right Atrial Phasic Function in Heart Failure With Preserved and Reduced Ejection Fraction. JACC Cardiovasc Imaging. 2018; 12(8 Pt 1):1460-1470. PMC: 6461533. DOI: 10.1016/j.jcmg.2018.08.020. View

LIEBOW A . Pulmonary emphysema with special reference to vascular changes. Am Rev Respir Dis. 1959; 80(1, Part 2):67-93. DOI: 10.1164/arrd.1959.80.1P2.67. View

Le T, Tan R, De Deyn M, Goh E, Han Y, Leong B . Cardiovascular magnetic resonance reference ranges for the heart and aorta in Chinese at 3T. J Cardiovasc Magn Reson. 2016; 18:21. PMC: 4830061. DOI: 10.1186/s12968-016-0236-3. View

Goddard P, Nicholson E, Laszlo G, Watt I . Computed tomography in pulmonary emphysema. Clin Radiol. 1982; 33(4):379-87. DOI: 10.1016/s0009-9260(82)80301-2. View

Krishnan S, Suarez-Martinez A, Bagher P, Gonzalez A, Liu R, Murfee W . Microvascular dysfunction and kidney disease: Challenges and opportunities?. Microcirculation. 2020; 28(3):e12661. PMC: 9990864. DOI: 10.1111/micc.12661. View

ABBOTT O, Hopkins W, VAN FLEIT W, Robinson J . A new approach to pulmonary emphysema. Thorax. 1953; 8(2):116-32. PMC: 1019252. DOI: 10.1136/thx.8.2.116. View

Barr R, Mesia-Vela S, Austin J, Basner R, Keller B, Reeves A . Impaired flow-mediated dilation is associated with low pulmonary function and emphysema in ex-smokers: the Emphysema and Cancer Action Project (EMCAP) Study. Am J Respir Crit Care Med. 2007; 176(12):1200-7. PMC: 2176103. DOI: 10.1164/rccm.200707-980OC. View

Kelshiker M, Seligman H, Howard J, Rahman H, Foley M, Nowbar A . Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis. Eur Heart J. 2021; 43(16):1582-1593. PMC: 9020988. DOI: 10.1093/eurheartj/ehab775. View

Harris B, Klein R, Jerosch-Herold M, Hoffman E, Ahmed F, Jacobs Jr D . The association of systemic microvascular changes with lung function and lung density: a cross-sectional study. PLoS One. 2013; 7(12):e50224. PMC: 3527439. DOI: 10.1371/journal.pone.0050224. View

10.

Hueper K, Vogel-Claussen J, Parikh M, Austin J, Bluemke D, Carr J . Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study. Am J Respir Crit Care Med. 2015; 192(5):570-80. PMC: 4595687. DOI: 10.1164/rccm.201411-2120OC. View

11.

PRATT P, Kilburn K . A modern concept of the emphysemas based on correlations of structure and function. Hum Pathol. 1970; 1(3):443-63. DOI: 10.1016/s0046-8177(70)80077-6. View

12.

van Rossum A, Visser F, Hofman M, Galjee M, Westerhof N, Valk J . Global left ventricular perfusion: noninvasive measurement with cine MR imaging and phase velocity mapping of coronary venous outflow. Radiology. 1992; 182(3):685-91. DOI: 10.1148/radiology.182.3.1535881. View

13.

Yoshida T, Tuder R . Pathobiology of cigarette smoke-induced chronic obstructive pulmonary disease. Physiol Rev. 2007; 87(3):1047-82. DOI: 10.1152/physrev.00048.2006. View

14.

Zhu Y, Wang Y, Gioia W, Yip R, Jirapatnakul A, Chung M . Visual scoring of aortic valve calcifications on low-dose CT in lung cancer screening. Eur Radiol. 2020; 30(5):2658-2668. DOI: 10.1007/s00330-019-06614-w. View

15.

Blume G, McLeod C, Barnes M, Seward J, Pellikka P, Bastiansen P . Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr. 2011; 12(6):421-30. DOI: 10.1093/ejechocard/jeq175. View

16.

Knight K, Horgan P, McMillan D, Roxburgh C, Park J . The relationship between aortic calcification and anastomotic leak following gastrointestinal resection: A systematic review. Int J Surg. 2019; 73:42-49. DOI: 10.1016/j.ijsu.2019.11.023. View

17.

Roversi S, Roversi P, Spadafora G, Rossi R, Fabbri L . Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest. 2013; 44(1):93-102. DOI: 10.1111/eci.12181. View

18.

Goto Y, Ishida M, Takase S, Sigfridsson A, Uno M, Nagata M . Comparison of Displacement Encoding With Stimulated Echoes to Magnetic Resonance Feature Tracking for the Assessment of Myocardial Strain in Patients With Acute Myocardial Infarction. Am J Cardiol. 2017; 119(10):1542-1547. DOI: 10.1016/j.amjcard.2017.02.029. View

19.

Hoit B . Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2013; 63(6):493-505. DOI: 10.1016/j.jacc.2013.10.055. View

20.

Barr R . The epidemiology of vascular dysfunction relating to chronic obstructive pulmonary disease and emphysema. Proc Am Thorac Soc. 2011; 8(6):522-7. PMC: 3359073. DOI: 10.1513/pats.201101-008MW. View