Changes of myocardial capillary density in progression of experimental lung emphysema

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

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.

Effect of chronic continuous or intermittent hypoxia and reoxygenation on cerebral capillary density and myelination

Chronic hypoxia, whether continuous (CCH) or intermittent (CIH), occurs in many neonatal pathological conditions, such as bronchopulmonary dysplasia and obstructive sleep apnea. In this study, we explored the effect of CCH and CIH on cerebral capillary density and myelination. We subjected CD-1 mice starting at postnatal day 2 to either CCH 11% oxygen (O(2)), or CIH 11% O(2) (4-min cycles), for periods of 2 and 4 wk followed by reoxygenation for 4 wk. Mice were deeply anesthetized and perfused. Brains were removed to fixative for 24 h, then paraffin-embedded. Coronal brain sections were taken for analysis. Immunocytochemistry for glucose transporter 1 was used to assess angiogenesis, and Luxol fast blue and fluoromyelin stains were used to assess myelination. Capillary density increased after 2-wk exposure to CIH and CCH. By 4 wk, capillary density increased in both CIH and CCH by 25% and 47%, respectively, in cortex and by 29% and 44%, respectively, in hippocampus (P < 0.05). There was a decrease in myelination in the corpus callosum of mice exposed to CIH (75% of control) and CCH (50% of control) (P < 0.05). Reoxygenation reversed the increased capillary density seen in CCH to normoxic values. However, dysmyelination that occurred in CCH-exposed mice did not show any improvement upon reoxygenation. We conclude that neonatal chronic hypoxia 1) induces brain angiogenesis, which is reversible with reoxygenation, and 2) irreversibly reduces the extent of myelination in the corpus callosum. This potential irreversible effect on myelination in early life can, therefore, have long-term and devastating effects.