Andrew J Collaro1,2, Anne B Chang3,4,5,6, Julie M Marchant3,4, Mark D Chatfield5,7, Annette Dent6,8,9, Kwun M Fong6,8,9, Margaret S McElrea3,4. 1. Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Level 5a, 501 Stanley St, South Brisbane, QLD, 4101, Australia. andrew.collaro@health.qld.gov.au. 2. Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia. andrew.collaro@health.qld.gov.au. 3. Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Level 5a, 501 Stanley St, South Brisbane, QLD, 4101, Australia. 4. Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia. 5. Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia. 6. Indigenous Respiratory Outreach Care, The Prince Charles Hospital, Brisbane, QLD, Australia. 7. Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. 8. Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia. 9. UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Abstract
PURPOSE: Low diffusing capacity of the lung for carbon monoxide (DLCO) and spirometry values are associated with increased mortality risk. However, associations between mortality risk and cardiovascular disease with the transfer coefficient of the lung for carbon monoxide (KCO) and alveolar volume (VA) are unknown. This cohort study: (i) evaluated whether DLCO, KCO, and VA abnormalities are independently associated with cardiovascular morbidity and/or elevated mortality risk and, (ii) compared these associations with those using spirometry values. METHODS: Gas-diffusing capacity and spirometry data of 1165 adults seen at specialist respiratory outreach clinics over an 8-year period (241 with cardiovascular disease; 108 deceased) were analysed using multivariable Cox and logistic regression. RESULTS: DLCO, KCO, and VA values below the lower limit of normal (< - 1.64 Z-scores) were associated with elevated cardiovascular disease prevalence [respective odds ratios of 1.83 (95% CI 1.31-2.55), 1.56 (95% CI 1.08-2.25), 2.20 (95% CI 1.60-3.01)] and increased all-cause mortality risk [respective hazard ratios of 2.99 (95% CI 1.83-4.90), 2.14 (95% CI 1.38-3.32), 2.75 (95% CI 1.18-2.58)], after adjustment for factors including age, personal smoking, and respiratory disease. Compared to similar levels of spirometry abnormality, DLCO, KCO, and VA were associated with similar or greater mortality risk, and similar cardiovascular disease prevalence. Analysis of only those patients with clinical normal spirometry values (n = 544) showed these associations persisted for DLCO. CONCLUSION: Low DLCO, KCO, and VA measurements are associated with cardiovascular disease prevalence. As risk factors of all-cause mortality, they are more sensitive than spirometry even among patients with no diagnosed respiratory disease.
PURPOSE: Low diffusing capacity of the lung for carbon monoxide (DLCO) and spirometry values are associated with increased mortality risk. However, associations between mortality risk and cardiovascular disease with the transfer coefficient of the lung for carbon monoxide (KCO) and alveolar volume (VA) are unknown. This cohort study: (i) evaluated whether DLCO, KCO, and VA abnormalities are independently associated with cardiovascular morbidity and/or elevated mortality risk and, (ii) compared these associations with those using spirometry values. METHODS: Gas-diffusing capacity and spirometry data of 1165 adults seen at specialist respiratory outreach clinics over an 8-year period (241 with cardiovascular disease; 108 deceased) were analysed using multivariable Cox and logistic regression. RESULTS: DLCO, KCO, and VA values below the lower limit of normal (< - 1.64 Z-scores) were associated with elevated cardiovascular disease prevalence [respective odds ratios of 1.83 (95% CI 1.31-2.55), 1.56 (95% CI 1.08-2.25), 2.20 (95% CI 1.60-3.01)] and increased all-cause mortality risk [respective hazard ratios of 2.99 (95% CI 1.83-4.90), 2.14 (95% CI 1.38-3.32), 2.75 (95% CI 1.18-2.58)], after adjustment for factors including age, personal smoking, and respiratory disease. Compared to similar levels of spirometry abnormality, DLCO, KCO, and VA were associated with similar or greater mortality risk, and similar cardiovascular disease prevalence. Analysis of only those patients with clinical normal spirometry values (n = 544) showed these associations persisted for DLCO. CONCLUSION: Low DLCO, KCO, and VA measurements are associated with cardiovascular disease prevalence. As risk factors of all-cause mortality, they are more sensitive than spirometry even among patients with no diagnosed respiratory disease.
Authors: Christina Magnussen; Francisco M Ojeda; Nargiz Rzayeva; Tanja Zeller; Christoph R Sinning; Norbert Pfeiffer; Manfred Beutel; Maria Blettner; Karl J Lackner; Stefan Blankenberg; Thomas Münzel; Klaus F Rabe; Philipp S Wild; Renate B Schnabel Journal: Int J Cardiol Date: 2017-02-03 Impact factor: 4.164
Authors: Sanja Stanojevic; Brian L Graham; Brendan G Cooper; Bruce R Thompson; Kim W Carter; Richard W Francis; Graham L Hall Journal: Eur Respir J Date: 2017-09-11 Impact factor: 16.671