Pulmonary vascular volume, impaired left ventricular filling and dyspnea: The MESA Lung Study

Carrie P. Aaron; Eric A. Hoffman; Joao A. C. Lima; Steven M. Kawut; Alain G. Bertoni; Jens Vogel-Claussen; Mohammadali Habibi; Katja Hueper; David R. Jacobs Jr.; Ravi Kalhan; Erin D. Michos; Wendy S. Post; Martin R. Prince; Benjamin M. Smith; Bharath Ambale Venkatesh; Chia-Ying Liu; Filip Zemrak; Karol Watson; Matthew Budoff; David A. Bluemke; R. Graham Barr

Pulmonary vascular volume, impaired left ventricular filling and dyspnea: The MESA Lung Study
Aaron, Carrie P.
Hoffman, Eric A.
Lima, Joao A. C.
Kawut, Steven M.
Bertoni, Alain G.
Vogel-Claussen, Jens
Habibi, Mohammadali
Hueper, Katja
Jacobs Jr., David R.
Kalhan, Ravi
Michos, Erin D.
Post, Wendy S.
Prince, Martin R.
Smith, Benjamin M.
Ambale Venkatesh, Bharath
Liu, Chia-Ying
Zemrak, Filip
Watson, Karol
Budoff, Matthew
Bluemke, David A.
Barr, R. Graham
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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.
Emphysema, Pulmonary
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Carrie P. Aaron, Eric A. Hoffman, Joao A. C. Lima, Steven M. Kawut, Alain G. Bertoni, Jens Vogel-Claussen, Mohammadali Habibi, Katja Hueper, David R. Jacobs Jr., Ravi Kalhan, Erin D. Michos, Wendy S. Post, Martin R. Prince, Benjamin M. Smith, Bharath Ambale Venkatesh, Chia-Ying Liu, Filip Zemrak, Karol Watson, Matthew Budoff, David A. Bluemke, R. Graham Barr, , Pulmonary vascular volume, impaired left ventricular filling and dyspnea: The MESA Lung Study, Columbia University Academic Commons, .

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