Samuel Y Ash1, Gonzalo Vegas Sanchez-Ferrero2, Mark L Schiebler3, Farbod N Rahaghi4, Ashish Rai5, Carolyn E Come4, James C Ross2, Alysha G Colon6, Juan Carlos Cardet7, Eugene R Bleecker8, Mario Castro9, John V Fahy10, Sean B Fain11, Benjamin M Gaston12, Eric A Hoffman13, Nizar N Jarjour14, Jason K Lempel15, David T Mauger16, Matthew C Tattersall17, Sally E Wenzel18, Bruce D Levy19, George R Washko4, Elliot Israel19, Raul San Jose Estepar2. 1. Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA. Electronic address: syash@bwh.harvard.edu. 2. Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA. 3. Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI. 4. Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA. 5. Department of Medicine, North Shore Medical Center, Salem, MA. 6. College of Medicine, University of Florida, Gainesville, FL. 7. Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, FL. 8. Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, AZ. 9. Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO. 10. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA. 11. Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI. 12. Division of Pulmonology, Allergy, and Immunology, and Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, OH. 13. Departments of Radiology, Biomedical Engineering, and Medicine, University of Iowa, Iowa City, IA. 14. Division of Pulmonary and Critical Care Medicine (Dr Jarjour), University of Wisconsin School of Medicine and Public Health, Madison, WI. 15. Department of Radiology, Cleveland Clinic, Cleveland, OH. 16. Division of Biostatistics and Bioinformatics, Penn State Eberly College of Science, University Park, PA. 17. Division of Cardiovascular Medicine (Dr Tattersall), University of Wisconsin School of Medicine and Public Health, Madison, WI. 18. Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA. 19. Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA.
Abstract
BACKGROUND: Relative enlargement of the pulmonary artery (PA) on chest CT imaging is associated with respiratory exacerbations in patients with COPD or cystic fibrosis. We sought to determine whether similar findings were present in patients with asthma and whether these findings were explained by differences in ventricular size. METHODS: We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left, and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI, and eETVVI, respectively). Associations between the cardiac and PA measures (PA-to-aorta [PA/A] ratio, eERVVI-to-eELVVI [eRV/eLV] ratio, eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed by Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated by multivariable linear and zero-inflated negative binomial regression. RESULTS: Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m2 smaller eETVVI than healthy control subjects (P = .003) and 14.1 mL/m2 smaller eETVVI than those with mild/moderate disease (P = .011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example, those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow-up than those with eETVVI greater than the median (P = .020). Neither PA/A nor eRV/eLV was associated with asthma severity or exacerbations. CONCLUSIONS: In patients with asthma, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01761630; URL: www.clinicaltrials.gov.
BACKGROUND: Relative enlargement of the pulmonary artery (PA) on chest CT imaging is associated with respiratory exacerbations in patients with COPD or cystic fibrosis. We sought to determine whether similar findings were present in patients with asthma and whether these findings were explained by differences in ventricular size. METHODS: We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left, and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI, and eETVVI, respectively). Associations between the cardiac and PA measures (PA-to-aorta [PA/A] ratio, eERVVI-to-eELVVI [eRV/eLV] ratio, eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed by Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated by multivariable linear and zero-inflated negative binomial regression. RESULTS:Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m2 smaller eETVVI than healthy control subjects (P = .003) and 14.1 mL/m2 smaller eETVVI than those with mild/moderate disease (P = .011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example, those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow-up than those with eETVVI greater than the median (P = .020). Neither PA/A nor eRV/eLV was associated with asthma severity or exacerbations. CONCLUSIONS: In patients with asthma, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01761630; URL: www.clinicaltrials.gov.
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