Ibrahim Musa Yola1, Albin Oh2, Gary F Mitchell3, George O'Connor4, Susan Cheng5, Ramachandran S Vasan1,6,7, Vanessa Xanthakis1,6,8. 1. Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States of America. 2. Department of Medicine, Boston Medical Center, Boston, MA, United States of America. 3. Cardiovascular Engineering, Inc., Norwood, MA, United States of America. 4. Department of Medicine, Pulmonary Center, Boston Medical Center, Boston University, Boston, MA, United States of America. 5. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America. 6. National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, MA, United States of America. 7. Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America. 8. Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America.
Abstract
BACKGROUND: Lung function abnormalities are ubiquitous in heart failure (HF). It is unclear, however, if abnormal lung diffusion capacity is associated with cardiac remodeling and antedates HF. We hypothesized that lower lung diffusion capacity for carbon monoxide (DLCO) is associated with worse left ventricular (LV) systolic and diastolic function cross-sectionally, and with higher risk of HF prospectively. METHODS: We evaluated 2423 Framingham Study participants (mean age 66 years, 55% women) free of HF who underwent routine echocardiography and pulmonary function tests. We used multivariable regression models to relate DLCO, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) to left ventricular ejection fraction (LVEF), left atrial (LA) emptying fraction (LAEF), E/e', E/A, LV mass, and LA diameter (LAD). Multivariable-adjusted Cox proportional hazards regression was used to relate DLCO, FEV1, and FVC to incident HF. RESULTS: In multivariable-adjusted cross-sectional analyses, DLCO, FEV1, and FVC (dependent variables) were associated positively with LVEF (βDLCO = 0.208, βFEV1 = 0.021, and βFVC = 0.025 per 5% increment in LVEF; p<0.005 for all), and LAEF (βDLCO = 0.707, βFEV1 = 0.058 and βFVC = 0.058 per 5% increment in LAEF; p<0.002 for all). DLCO and FVC were inversely related to E/A (βDLCO = -0.289, βFVC = -0.047 per SD increment in E/A; p<0.001 for all). Additionally, DLCO, FEV1 and FVC were inversely related to HF risk (108 events, median follow-up 9.7 years; multivariable-adjusted hazard ratios per SD increment 0.90, 95% CI 0.86-0.95; 0.42, 95% CI 0.28-0.65, and 0.51, 95% CI 0.36-0.73, respectively). These results remained robust in analyses restricted to non-smokers. CONCLUSIONS: Our large community-based observations are consistent with the concept that lower lung diffusion capacity and expiratory flow rates are associated with cardiac remodeling and may antedate HF. Additional studies are needed to confirm our findings and to evaluate the prognostic utility of pulmonary function testing for predicting HF.
BACKGROUND: Lung function abnormalities are ubiquitous in heart failure (HF). It is unclear, however, if abnormal lung diffusion capacity is associated with cardiac remodeling and antedates HF. We hypothesized that lower lung diffusion capacity for carbon monoxide (DLCO) is associated with worse left ventricular (LV) systolic and diastolic function cross-sectionally, and with higher risk of HF prospectively. METHODS: We evaluated 2423 Framingham Study participants (mean age 66 years, 55% women) free of HF who underwent routine echocardiography and pulmonary function tests. We used multivariable regression models to relate DLCO, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) to left ventricular ejection fraction (LVEF), left atrial (LA) emptying fraction (LAEF), E/e', E/A, LV mass, and LA diameter (LAD). Multivariable-adjusted Cox proportional hazards regression was used to relate DLCO, FEV1, and FVC to incident HF. RESULTS: In multivariable-adjusted cross-sectional analyses, DLCO, FEV1, and FVC (dependent variables) were associated positively with LVEF (βDLCO = 0.208, βFEV1 = 0.021, and βFVC = 0.025 per 5% increment in LVEF; p<0.005 for all), and LAEF (βDLCO = 0.707, βFEV1 = 0.058 and βFVC = 0.058 per 5% increment in LAEF; p<0.002 for all). DLCO and FVC were inversely related to E/A (βDLCO = -0.289, βFVC = -0.047 per SD increment in E/A; p<0.001 for all). Additionally, DLCO, FEV1 and FVC were inversely related to HF risk (108 events, median follow-up 9.7 years; multivariable-adjusted hazard ratios per SD increment 0.90, 95% CI 0.86-0.95; 0.42, 95% CI 0.28-0.65, and 0.51, 95% CI 0.36-0.73, respectively). These results remained robust in analyses restricted to non-smokers. CONCLUSIONS: Our large community-based observations are consistent with the concept that lower lung diffusion capacity and expiratory flow rates are associated with cardiac remodeling and may antedate HF. Additional studies are needed to confirm our findings and to evaluate the prognostic utility of pulmonary function testing for predicting HF.
Authors: S R Ommen; R A Nishimura; C P Appleton; F A Miller; J K Oh; M M Redfield; A J Tajik Journal: Circulation Date: 2000-10-10 Impact factor: 29.690
Authors: Bruce H Culver; Brian L Graham; Allan L Coates; Jack Wanger; Cristine E Berry; Patricia K Clarke; Teal S Hallstrand; John L Hankinson; David A Kaminsky; Neil R MacIntyre; Meredith C McCormack; Margaret Rosenfeld; Sanja Stanojevic; Daniel J Weiner Journal: Am J Respir Crit Care Med Date: 2017-12-01 Impact factor: 21.405