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Hermann EA, Motahari A, Hoffman EA, Allen N, Bertoni AG, Bluemke DA, Eskandari A, Gerard SE, Guo J, Hiura GT, Kaczka DW, Michos ED, Nagpal P, Pankow J, Shah S, Smith BM, Stukovsky KH, Sun Y, Watson K, Barr RG. Pulmonary Blood Volume Among Older Adults in the Community: The MESA Lung Study. Circ Cardiovasc Imaging 2022; 15:e014380. [PMID: 35938411 PMCID: PMC9387743 DOI: 10.1161/circimaging.122.014380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The pulmonary vasculature is essential for gas exchange and impacts both pulmonary and cardiac function. However, it is difficult to assess and its characteristics in the general population are unknown. We measured pulmonary blood volume (PBV) noninvasively using contrast enhanced, dual-energy computed tomography to evaluate its relationship to age and symptoms among older adults in the community. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) is an ongoing community-based, multicenter cohort. All participants attending the most recent MESA exam were selected for contrast enhanced dual-energy computed tomography except those with estimated glomerular filtration rate <60 mL/min per 1.73 m2. PBV was calculated by material decomposition of dual-energy computed tomography images. Multivariable models included age, sex, race/ethnicity, education, height, weight, smoking status, pack-years, and scanner model. RESULTS The mean age of the 727 participants was 71 (range 59-94) years, and 55% were male. The race/ethnicity distribution was 41% White, 29% Black, 17% Hispanic, and 13% Asian. The mean±SD PBV in the youngest age quintile was 547±180 versus 433±194 mL in the oldest quintile (P<0.001), with an approximately linear decrement of 50 mL per 10 years of age ([95% CI, 32-67]; P<0.001). Findings were similar with multivariable adjustment. Lower PBV was associated independently with a greater dyspnea after a 6-minute walk (P=0.04) and greater composite dyspnea symptom scores (P=0.02). Greater PBV was also associated with greater height, weight, lung volume, Hispanic race/ethnicity, and nonsmoking history. CONCLUSIONS Pulmonary blood volume was substantially lower with advanced age and was associated independently with greater symptoms scores in the elderly.
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Affiliation(s)
- Emilia A. Hermann
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | | | | | | | | | | | | | | | - Grant T. Hiura
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | | | - Prashant Nagpal
- 2. University of Iowa, Iowa City, IA
- 5. University of Wisconsin-Madison, Madison WI
| | - Jim Pankow
- 7. University of Minnesota, Minneapolis, MN
| | | | - Benjamin M Smith
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Yifei Sun
- 9. Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Karol Watson
- 10. University of California, Los Angeles, Los Angeles, CA
| | - R. Graham Barr
- 1. Department of Medicine, Columbia University Medical Center, New York, NY
- 11. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY
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Aaron CP, Hoffman EA, Lima JAC, Kawut SM, Bertoni AG, Vogel-Claussen J, Habibi M, Hueper K, Jacobs DR, Kalhan R, Michos ED, Post WS, Prince MR, Smith BM, Ambale-Venkatesh B, Liu CY, Zemrak F, Watson KE, Budoff M, Bluemke DA, Barr RG. Pulmonary vascular volume, impaired left ventricular filling and dyspnea: The MESA Lung Study. PLoS One 2017; 12:e0176180. [PMID: 28426728 PMCID: PMC5398710 DOI: 10.1371/journal.pone.0176180] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 04/06/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evaluation of impaired left ventricular (LV) filling has focused on intrinsic causes of LV dysfunction; however, pulmonary vascular changes may contribute to reduced LV filling and dyspnea. We hypothesized that lower total pulmonary vascular volume (TPVV) on computed tomography (CT) would be associated with dyspnea and decrements in LV end-diastolic volume, particularly among ever-smokers. METHODS The Multi-Ethnic Study of Atherosclerosis recruited adults without clinical cardiovascular disease in 2000-02. In 2010-12, TPVV was ascertained as the volume of arteries and veins in the lungs detectable on non-contrast chest CT (vessels ≥1 mm diameter). Cardiac measures were assessed by magnetic resonance imaging (MRI). Dyspnea was self-reported. RESULTS Of 2303 participants, 53% had ever smoked cigarettes. Among ever-smokers, a lower TPVV was associated with a lower LV end-diastolic volume (6.9 mL per SD TPVV), stroke volume, and cardiac output and with dyspnea (all P-values <0.001). Findings were similar among those without lung disease and those with 0-10 pack-years but were mostly non-significant among never-smokers. TPVV was associated smaller left atrial volume but not with LV ejection fraction or MRI measures of impaired LV relaxation. In a second sample of ever-smokers, a lower pulmonary microvascular blood volume on contrast-enhanced MRI was also associated with a lower LV end-diastolic volume (P-value = 0.008). CONCLUSION Reductions in pulmonary vascular volume were associated with lower LV filling and dyspnea among ever-smokers, including those without lung disease, suggesting that smoking-related pulmonary vascular changes may contribute to symptoms and impair cardiac filling and function without evidence of impaired LV relaxation.
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Affiliation(s)
- Carrie P. Aaron
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States of America
| | - Joao A. C. Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Steven M. Kawut
- Departments of Medicine and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Alain G. Bertoni
- Departments of Medicine and Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, United States of America
| | - Jens Vogel-Claussen
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Mohammadali Habibi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Katja Hueper
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Erin D. Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Wendy S. Post
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Martin R. Prince
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Benjamin M. Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Bharath Ambale-Venkatesh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Chia-Ying Liu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - Filip Zemrak
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - Karol E. Watson
- Department of Medicine, University of California, Los Angeles, CA, United States of America
| | - Matthew Budoff
- Department of Medicine, University of California, Los Angeles, CA, United States of America
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center; Bethesda, MD, United States of America
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Lewis ML, Gnoj J, Fisher VJ, Christianson LC. Determinants of pulmonary blood volume. J Clin Invest 1970; 49:170-82. [PMID: 4902826 PMCID: PMC322455 DOI: 10.1172/jci106216] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Pulmonary blood volume was determined by the radiocardiographic technique in 49 patients coming to cardiac catheterization. Since this method has not been directly compared with the more commonly used double injection of dye. 25 comparisons were carried out in 13 patients of the series. Agreement was good over a range of 4.5-21.1 heart cycles since there was no statistically significant difference between transit time values measured by the two methods. The relation of pulmonary blood volume to other hemodynamic factors in these 49 patients, with and without cardiac or pulmonary disease, was evaluated by means of multiple regression analysis. The analysis carried out for mean transit time indicates that this parameter varies predominately with flow. Pulmonary blood volume, in this series of resting recumbent individuals, varies to a significant degree only with total blood volume and with pulmonary venous pressure. No parameters of vascular distensibility, such as pulmonary vascular resistance, were found to affect the volume of blood in the lungs. The fact that variations in pulmonary blood volume among the subjects could be described by a multiple regression equation linear with respect to total blood volume and pulmonary venous pressure indicates that these variations are the result of passive distention of components of the vascular bed.
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