1
|
Freund O, Shetrit A, Bar-Shai A, Zornitzki L, Frydman S, Banai A, Shamir RA, Ben-Shoshan J, Arbel Y, Banai S, Konigstein M. Smoking and Respiratory Diseases in Patients with Coronary Microvascular Dysfunction. Am J Med 2024; 137:538-544.e1. [PMID: 38485108 DOI: 10.1016/j.amjmed.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/18/2024] [Accepted: 02/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Coronary microvascular disease (CMD) is common in patients with and without obstructive coronary artery disease, and is associated with adverse clinical outcomes. Respiratory-related variables are associated with pulmonary and systemic microvascular dysfunction, while evidence about their relationship with CMD is limited. We aim to evaluate respiratory-related variables as risk factors of CMD. METHODS This is an observational, single-center study enrolling consecutive patients undergoing invasive evaluation of coronary microvascular function in the catheterization laboratory. Patients with evidence of obstructive coronary artery disease or with missing data were excluded. Associations between respiratory-related variables and indices of CMD were assessed using univariate and multivariate regression models. RESULTS Overall, 266 patients (mean age 67 ± 11 years, 59% females) were included in the current analysis. Of those, 155 (58%) had evidence of CMD. Among the respiratory variables, independent predictors of CMD were current smoking (adjusted odds ratio [AOR] 2.5; 95% confidence interval [CI], 1.2-5; P = .01) and obstructive sleep apnea (AOR 5.7; 95% CI, 1.2-26; P = .03), while chronic obstructive pulmonary disease was not. Among ever-smokers, higher smoking pack-years was an independent risk factor for CMD (median 35 vs 25 pack-years, AOR 1.09; 95% CI, 1.04-1.13; P < .01), and was associated with higher rates of pathologic index of microcirculatory resistance and resistive reserve ratio. CONCLUSION In patients undergoing invasive coronary microvascular evaluation, current smoking and obstructive sleep apnea are independently associated with CMD. Among smokers, higher pack-years is a strong predictor for CMD. Our findings should raise awareness for prevention and possible treatment options.
Collapse
Affiliation(s)
- Ophir Freund
- Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel; Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Aviel Shetrit
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Lior Zornitzki
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel; Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Shir Frydman
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel; Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Ariel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Reut Amar Shamir
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Jeremy Ben-Shoshan
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel.
| |
Collapse
|
2
|
Hartmann JP, Lassen ML, Mohammad M, Iepsen UW, Mortensen J, Hasbak P, Berg RMG. Pulmonary blood volume measured by 82Rb-PET in patients with chronic obstructive pulmonary disease: a retrospective cohort study. J Appl Physiol (1985) 2024; 136:1276-1283. [PMID: 38602000 DOI: 10.1152/japplphysiol.00058.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), pulmonary vascular dysfunction and destruction are observable before the onset of detectable emphysema, but it is unknown whether this is associated with central hypovolemia. We investigated if patients with COPD have reduced pulmonary blood volume (PBV) evaluated by 82Rb-positron emission tomography (PET) at rest and during adenosine-induced hyperemia. This single-center retrospective cohort study assessed 6,301 82Rb-PET myocardial perfusion imaging (MPI) examinations performed over a 6-yr period. We compared 77 patients with COPD with 44 healthy kidney donors (controls). Cardiac output ([Formula: see text]) and mean 82Rb bolus transit time (MBTT) were used to calculate PBV. [Formula: see text] was similar at rest (COPD: 3,649 ± 120 mL vs. control: 3,891 ± 160 mL, P = 0.368) but lower in patients with COPD compared with controls during adenosine infusion (COPD: 5,432 ± 124 mL vs. control: 6,185 ± 161 mL, P < 0.050). MBTT was shorter in patients with COPD compared with controls at rest (COPD: 8.7 ± 0.28 s vs. control: 11.4 ± 0.37 s, P < 0.001) and during adenosine infusion (COPD: 9.2 ± 0.28 s vs. control: 10.2 ± 0.37 s, P < 0.014). PBV was lower in patients with COPD, even after adjustment for body surface area, sex, and age at rest [COPD: 530 (29) mL vs. 708 (38) mL, P < 0.001] and during adenosine infusion [COPD: 826 (29) mL vs. 1,044 (38) mL, P < 0.001]. In conclusion, patients with COPD show evidence of central hypovolemia, but it remains to be determined whether this has any diagnostic or prognostic impact.NEW & NOTEWORTHY The present study demonstrated that patients with chronic obstructive pulmonary disease (COPD) exhibit central hypovolemia compared with healthy controls. Pulmonary blood volume may thus be a relevant physiological and/or clinical outcome measure in future COPD studies.
Collapse
Affiliation(s)
- Jacob Peter Hartmann
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Lyngby Lassen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Milan Mohammad
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Winning Iepsen
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
| | - Jann Mortensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Ronan M G Berg
- Centre for Physical Activity Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| |
Collapse
|
3
|
Kubooka M, Ishida M, Takafuji M, Ito H, Kokawa T, Nakamura S, Domae K, Araki S, Ichikawa Y, Murashima S, Sakuma H. 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. Magn Reson Med Sci 2024; 23:27-38. [PMID: 36517009 PMCID: PMC10838718 DOI: 10.2463/mrms.mp.2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/04/2022] [Indexed: 01/05/2024] Open
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.
Collapse
Affiliation(s)
- Makiko Kubooka
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | | | - Haruno Ito
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Takanori Kokawa
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Satoshi Nakamura
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Kensuke Domae
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Suguru Araki
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| |
Collapse
|
4
|
Pandat S, Nagaura T, Nair SG, Uy-Evanado A, Stecker EC, Nichols GA, Jui J, Shiota T, Chugh SS, Reinier K. An association between right ventricular dysfunction and sudden cardiac death. Heart Rhythm 2019; 17:169-174. [PMID: 31634617 DOI: 10.1016/j.hrthm.2019.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The effectiveness of severely reduced left ventricular ejection fraction (LVEF <35%) as a predictor of sudden cardiac death (SCD) has diminished, and improvements in risk stratification await discovery of novel markers. Right ventricular (RV) abnormalities can be observed in conditions such as chronic obstructive pulmonary disease and sleep apnea, which have been linked to SCD. OBJECTIVE The purpose of this study was to evaluate whether RV abnormalities were associated with SCD after accounting for LVEF and other patient characteristics. METHODS In a large, prospective ongoing community-based study of SCD in the Portland, Oregon, metropolitan area, SCD cases (age ≥18 years; 2002-2014) were compared to controls with coronary artery disease but no SCD. Using a novel archive of digital echocardiograms, a standardized approach was used to evaluate RV basal diameter, RV end-diastolic area, and right ventricular fractional area change (RVFAC). RESULTS A total of 350 subjects were studied, including 81 SCD cases (age 68.7 ± 13.6 years; 73% male) and 269 controls (age 66.5 ± 10.2 years; 69% male). In multivariate analysis, RVFAC was significantly associated with SCD (odds ratio 1.14 for each 5% decrease; 95% confidence interval 1.03-1.25; P = .01). When modeled with LVEF ≤35%, RVFAC ≤35% was significantly associated with increased risk of SCD. Individuals with both left ventricular and RV dysfunction had a 3× higher odds of SCD than those with neither (odds ratio 3.19; 95% confidence interval 1.33-7.68; P = .01). CONCLUSION RV dysfunction was associated with a significantly increased risk of SCD independent of LVEF and, when combined with LVEF, had additive effects on SCD risk.
Collapse
Affiliation(s)
- Summit Pandat
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takafumi Nagaura
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sandeep G Nair
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Audrey Uy-Evanado
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sumeet S Chugh
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kyndaron Reinier
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| |
Collapse
|
5
|
Charytan DM, Skali H, Shah NR, Veeranna V, Cheezum MK, Taqueti VR, Kato T, Bibbo CR, Hainer J, Dorbala S, Blankstein R, Di Carli MF. Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage. Kidney Int 2017; 93:501-509. [PMID: 29032954 DOI: 10.1016/j.kint.2017.07.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/14/2017] [Accepted: 07/27/2017] [Indexed: 01/09/2023]
Abstract
Microvascular rarefaction is found in experimental uremia, but data from patients with chronic kidney disease (CKD) are limited. We therefore quantified absolute myocardial blood flow and coronary flow reserve (the ratio of peak to resting flow) from myocardial perfusion positron emission tomography scans at a single institution. Individuals were classified into standard CKD categories based on the estimated glomerular filtration rate. Associations of coronary flow reserve with CKD stage and cardiovascular mortality were analyzed in models adjusted for cardiovascular risk factors. The coronary flow reserve was significantly associated with CKD stage, declining in early CKD, but it did not differ significantly among individuals with stage 4, 5, and dialysis-dependent CKD. Flow reserve with preserved kidney function was 2.01, 2.06 in stage 1 CKD, 1.91 in stage 2, 1.68 in stage 3, 1.54 in stage 4, 1.66 in stage 5, and 1.55 in dialysis-dependent CKD. Coronary flow reserve was significantly associated with cardiovascular mortality in adjusted models (hazard ratio 0.76, 95% confidence interval: 0.63-0.92 per tertile of coronary flow reserve) without evidence of effect modification by CKD. Thus, coronary flow reserve is strongly associated with cardiovascular risk regardless of CKD severity and is low in early stage CKD without further decrement in stage 5 or dialysis-dependent CKD. This suggests that CKD physiology rather than the effects of dialysis is the primary driver of microvascular disease. Our findings highlight the potential contribution of microvascular dysfunction to cardiovascular risk in CKD and the need to define mechanisms linking low coronary flow reserve to mortality.
Collapse
Affiliation(s)
- David M Charytan
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Renal Division, Brigham & Women's Hospital, Boston, Massachusetts, USA.
| | - Hicham Skali
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Nishant R Shah
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Vikas Veeranna
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Michael K Cheezum
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Viviany R Taqueti
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Takashi Kato
- Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Gifu Prefectural General Medical Center, Gifu City, Japan
| | - Courtney R Bibbo
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Jon Hainer
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Ron Blankstein
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Marcelo F Di Carli
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Onishi K. Total management of chronic obstructive pulmonary disease (COPD) as an independent risk factor for cardiovascular disease. J Cardiol 2017; 70:128-134. [PMID: 28325523 DOI: 10.1016/j.jjcc.2017.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 12/28/2022]
Abstract
Patients with cardiovascular disease (CVD) often have multiple comorbid conditions that may interact with each other, confound the choice of treatments, and reduce mortality. Chronic obstructive pulmonary disease (COPD) is one of the most important comorbidities of CVD, which causes serious consequences in patients with ischemic heart disease, stroke, arrhythmia, and heart failure. COPD shares common risk factors such as tobacco smoking and aging with CVD, is associated with less physical activity, and produces systemic inflammation and oxidative stress. Overall, patients with COPD have a 2-3-fold increased risk of CVD as compared to age-matched controls when adjusted for tobacco smoking. Chronic heart failure (HF) is a frequent and important comorbidity which has a significant impact on prognosis in COPD, and vice versa. HF overlaps in symptoms and signs and has a common comorbidity with COPD, so that diagnosis of COPD is difficult in patients with HF. The combination of HF and COPD presents many therapeutic challenges including beta-blockers (BBs) and beta-agonists. Inhaled long-acting bronchodilators including beta2-agonists and anticholinergics for COPD would not worsen HF. Diuretics are relatively safe, and angiotensin-converting enzyme inhibitors are preferred to treat HF accompanied with COPD. BBs are only relatively contraindicated in asthma, but not in COPD. Low doses of cardioselective BBs should be aggressively initiated in clinically stable patients with HF accompanied with COPD combined with close monitoring for signs of airway obstruction and gradually up-titrated to the maximum tolerated dose. Encouraging appropriate and aggressive treatment for both HF and COPD should be recommended to improve quality of life and mortality in HF patients with COPD.
Collapse
|
7
|
Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1734190. [PMID: 27088083 PMCID: PMC4806267 DOI: 10.1155/2016/1734190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/11/2016] [Indexed: 01/21/2023]
Abstract
Technological advances in magnetic resonance imaging (MRI) and computed tomography (CT), including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET). This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD), as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.
Collapse
|
8
|
Weinreich UM, Thomsen LP, Brock C, Karbing DS, Rees SE. Diffusion capacity of the lung for carbon monoxide - A potential marker of impaired gas exchange or of systemic deconditioning in chronic obstructive lung disease? Chron Respir Dis 2015; 12:357-64. [PMID: 26323278 DOI: 10.1177/1479972315601946] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Gas exchange impairment is primarily caused by ventilation-perfusion mismatch in chronic obstructive pulmonary disease (COPD), where diffusing capacity of the lungs for carbon monoxide (DLCO) remains the clinical measure. This study investigates whether DLCO: (1) can predict respiratory impairment in COPD, that is, changes in oxygen and carbon dioxide (CO2); (2) is associated with combined risk assessment score for COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) score); and (3) is associated with blood glucose and body mass index (BMI). Fifty patients were included retrospectively. DLCO; arterial blood gas at inspired oxygen (FiO2) = 0.21; oxygen saturation (SpO2) at FiO2 = 0.21 (SpO2 (21)) and FiO2 = 0.15 (SpO2 (15)) were registered. Difference between arterial and end-tidal CO2 (ΔCO2) was calculated. COPD severity was stratified according to GOLD score. The association between DLCO, SpO2, ΔCO2, GOLD score, blood glucose, and BMI was investigated. Multiple regression showed association between DLCO and GOLD score, BMI, and glucose level (R (2) = 0.6, p < 0.0001). Linear and multiple regression showed an association between DLCO and SpO2 (21) (R (2) = 0.3, p = 0.001 and p = 0.03, respectively) without contribution from SpO2 (15) or ΔCO2. A stronger association between DLCO and GOLD score than between DLCO and SpO2 could indicate that DLCO is more descriptive of systemic deconditioning than gas exchange in COPD patients. However, further larger studies are needed. A weaker association is seen between DLCO and SpO2 (21) without contribution from SpO2 (15) and ΔCO2. This could indicate that DLCO is more descriptive of systemic deconditioning than gas exchange in COPD patients. However, further larger studies are needed.
Collapse
Affiliation(s)
- Ulla Møller Weinreich
- Department of Pulmonary Medicine, Aalborg University Hospital, Aalborg, Denmark Respiratory and critical care group (RCARE), Centre for Model Based Medical Decision Support Systems, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark The Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Pilegaard Thomsen
- Respiratory and critical care group (RCARE), Centre for Model Based Medical Decision Support Systems, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Christina Brock
- Mesh-Sense, Aalborg University Hospital, Aalborg, Denmark Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Aalborg, Denmark
| | - Dan Stieper Karbing
- Respiratory and critical care group (RCARE), Centre for Model Based Medical Decision Support Systems, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stephen Edward Rees
- Respiratory and critical care group (RCARE), Centre for Model Based Medical Decision Support Systems, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
9
|
Edvardsen T, Bucciarelli-Ducci C, Saraste A, Pierard LA, Knuuti J, Maurer G, Habib G, Lancellotti P. The year 2014 in the European Heart Journal - Cardiovascular Imaging. Part I. Eur Heart J Cardiovasc Imaging 2015; 16:712-8. [DOI: 10.1093/ehjci/jev150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
10
|
Magne J, Habib G, Cosyns B, Donal E, Miller O, Neglia D, Petersen SE, Lancellotti P. EuroEcho-Imaging 2014: highlights. Eur Heart J Cardiovasc Imaging 2015; 16:703-11. [PMID: 25920925 DOI: 10.1093/ehjci/jev084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 11/14/2022] Open
Abstract
The annual meeting of the European Association of Echocardiography (EuroEcho-Imaging) was held in Vienna, Austria. In the present paper, we present a summary of the 'Highlights' session.
Collapse
Affiliation(s)
- Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges F-87042, France Faculté de médecine de Limoges, INSERM 1094, 2, rue Marcland, 87000 Limoges, France
| | - Gilbert Habib
- Department of Cardiology, Aix-Marseille Université, 13284 Marseille, France La Timone Hospital, 13005 Marseille, France
| | | | - Erwan Donal
- CIC-IT U 804, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU RENNES, Rennes, France
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Danilo Neglia
- Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, UK
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium GVM Care and Research, E.S. Health Science Foundation, Lugo, Ravenna, Italy
| |
Collapse
|