Smaller left ventricle size at noncontrast ct is associated with lower mortality in copdgene participants

George R. Washko; Pietro Nardelli; Samuel Y. Ash; Farbod N. Rahaghi; Gonzalo Vegas Sanchez-Ferrero; Carolyn E. Come; Mark T. Dransfield; Ravi Kalhan; Mei Lan K. Han; Surya P. Bhatt; J. Michael Wells; Carrie L. Pistenmaa; Alejandro A. Diaz; James C. Ross; Stephen Rennard; Gabriela Querejeta Roca; Amil M. Shah; Kendra Young; Gregory L. Kinney; John E. Hokanson; Alvar Agustí; Raúl San José Estépar

doi:10.1148/radiol.2020191793

Smaller left ventricle size at noncontrast ct is associated with lower mortality in copdgene participants

George R. Washko^*, Pietro Nardelli, Samuel Y. Ash, Farbod N. Rahaghi, Gonzalo Vegas Sanchez-Ferrero, Carolyn E. Come, Mark T. Dransfield, Ravi Kalhan, Mei Lan K. Han, Surya P. Bhatt, J. Michael Wells, Carrie L. Pistenmaa, Alejandro A. Diaz, James C. Ross, Stephen Rennard, Gabriela Querejeta Roca, Amil M. Shah, Kendra Young, Gregory L. Kinney, John E. HokansonAlvar Agustí, Raúl San José Estépar

^*Corresponding author for this work

Medicine, Pulmonary Division

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Background: Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose: To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LVEV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LVEV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods: The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LVEV, distal pulmonary venous blood volume for vessels smaller than 5 mm2 in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LVEV as well as the association of LVEV with health status using the St George’s Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results: The median age of the cohort was 64 years (interquartile range, 57–70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LVEV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men (P , .001 for both). In fully adjusted models, higher emphysema percentage (b = –4.2; 95% confidence interval [CI]: –5.0, 23.4; P , .001), venous BV5 (b = 7.0; 95% CI: 5.7, 8.2; P , .001), and pectoralis muscle area (b = 2.7; 95% CI: 1.2, 4.1; P , .001) were independently associated with reduced LVEV. Reductions in LVEV were associated with improved health status (b = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (b = –12.2; 95% CI: –15.2, –9.3). These effects were greater in women than in men. The effect of reduced LVEV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion: In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality.

Original language	English (US)
Pages (from-to)	208-215
Number of pages	8
Journal	Radiology
Volume	296
Issue number	1
DOIs	https://doi.org/10.1148/radiol.2020191793
State	Published - Jul 2020

Funding

cle: institution received a grant from the National Heart, Lung, and Blood Institute. Activities not related to the present article: is a consultant for GlaxoSmithKline; institution has grants/grants pending with Boehringer Ingelheim; is a founder and member of the scientific advisory board of Quantitative Imaging Solutions; chaired the data and safety monitoring board for a Pulmonx study; consulted for Janssen Pharmaceuticals and Novartis. Other relationships: disclosed no relevant relationships. P.N. disclosed no relevant relationships. S.Y.A. Activities related to the present article: institution received grants from the National Institutes of Health and the Pulmonary Fibrosis Foundation. Activities not related to the present article: has equity interest in Quantitative Imaging Solutions. Other relationships: disclosed no relevant relationships. F.N.R. Activities related to the present article: institution received a grant from the National Institutes of Health. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. G.V.S.F. disclosed no relevant relationships. C.E.C. Activities related to the present article: institution received grants from the National Institutes of Health and the National Heart, Lung, and Blood Institute. Activities not related to the present article: has grants/grants pending with the U.S. Department of Defense; received payment for development of Brigham Board Review in Critical Care course; receives honorarium as a member of the outcomes assessment committee for the Pulmonary Embolism Prevention after Hip and Knee Replacement trial. Other relationships: disclosed no relevant relationships. M.T.D. Activities related to the present article: institution received a grant from the National Institutes of Health. Activities not related to the present article: is a consultant for AstraZeneca, GlaxoSmithKline, PneumRx/BTG, Quark, and Mereo. Other relationships: disclosed no relevant relationships. R.K. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for AstraZeneca, Boehringer Ingelheim, Boston Consulting Group, Boston Scientific, CVS Caremark, and GlaxoSmithKline; has grants/ grants pending with AstraZeneca, GlaxoSmithKline, PneumRx/BTG, and Spiration; has received payment for lectures, including service on speakers bureaus, from GlaxoSmithKline; received payment from WebMD/Medscape for development of educational presentations. Other relationships: disclosed no relevant relationships. M.K.H. Activities related to the present article: institution received a grant from the National Heart, Lung, and Blood Institute. Activities not related to the present article: is a consultant for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck, and Mylan; has grants/grants pending with Novartis and Sunovion; receives royalties from UpToDate. Other relationships: disclosed no relevant relationships. S.P.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: receives payment for board membership from GlaxoSmithKline; is a consultant for Sunovion; has grants/grants pending with the National Institutes of Health. Other relationships: disclosed no relevant relationships. J.M.W. Activities related to the present article: institution received a grant from the National Institutes of Health. Activities not related to the present article: is a consultant for the advisory boards of AstraZeneca, BioPharma, Boehringer Ingelheim, GlaxoSmithKline, and Mereo; institution has grants/grants pending with the National Institutes of Health. Other relationships: disclosed no relevant relationships. C.P.A. Activities related to the present article: institution received a grant from the National Institutes of Health. Activities not related to the present article: institution has grants/grants pending with Alpha 1 Foundation, Boerhinger Ingelheim, and the National Institutes of Health; institution received payment from Pri-Med CME for development of educational presentations. Other relationships: disclosed no relevant relationships. A.A.D. Activities related to the present article: institution received a grant from the National Heart, Lung, and Blood Institute. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. J.C.R. Activities related to the present article: institution received a grant from the National Institutes of Health. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. S.R. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for BerGenBio; institution has grants/grants pending with the National Heart, Lung, and Blood Institute and the Patient-Centered Outcomes Research Institute; holds stock/stock options in AstraZeneca; received reimbursement for travel/accommodations/meeting expenses from the German Center for Lung Research. Other relationships: disclosed no relevant relationships. G.Q.R. disclosed no relevant relationships. A.M.S. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is a consultant for Bellerophon Therapeutics and Philips Ultrasound; institution has grants/grants pending with Novartis. Other relationships: disclosed no relevant relationships. K.Y. Activities related to the present article: institution received a grant from the National Institutes of Health. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. G.L.K. Activities related to the present article: received a grant from the National Institutes of Health and the National Heart, Lung, and Blood Institute. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. J.E.H. disclosed no relevant relationships. A.A. disclosed no relevant relationships. R.S.J.E. Activities related to the present article: institution received a grant from the National Institutes of Health and the National Heart, Lung, and Blood Institute. Activities not related to the present article: is a consultant for Eolo Medical; received payment for lectures, including service on speakers bureaus, from Chiesi, Boehringer Ingelheim, and Toshiba; is a founder of and has equity in Quantitative Imaging Solutions. Other relationships: disclosed no relevant relationships.

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1148/radiol.2020191793

Cite this

Washko, G. R., Nardelli, P., Ash, S. Y., Rahaghi, F. N., Sanchez-Ferrero, G. V., Come, C. E., Dransfield, M. T., Kalhan, R., Han, M. L. K., Bhatt, S. P., Wells, J. M., Pistenmaa, C. L., Diaz, A. A., Ross, J. C., Rennard, S., Roca, G. Q., Shah, A. M., Young, K., Kinney, G. L., ... José Estépar, R. S. (2020). Smaller left ventricle size at noncontrast ct is associated with lower mortality in copdgene participants. Radiology, 296(1), 208-215. https://doi.org/10.1148/radiol.2020191793

@article{6eed2fd7abb74527ab9d89701f10da39,

title = "Smaller left ventricle size at noncontrast ct is associated with lower mortality in copdgene participants",

abstract = "Background: Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose: To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LVEV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LVEV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods: The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LVEV, distal pulmonary venous blood volume for vessels smaller than 5 mm2 in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LVEV as well as the association of LVEV with health status using the St George{\textquoteright}s Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results: The median age of the cohort was 64 years (interquartile range, 57–70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LVEV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men (P , .001 for both). In fully adjusted models, higher emphysema percentage (b = –4.2; 95% confidence interval [CI]: –5.0, 23.4; P , .001), venous BV5 (b = 7.0; 95% CI: 5.7, 8.2; P , .001), and pectoralis muscle area (b = 2.7; 95% CI: 1.2, 4.1; P , .001) were independently associated with reduced LVEV. Reductions in LVEV were associated with improved health status (b = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (b = –12.2; 95% CI: –15.2, –9.3). These effects were greater in women than in men. The effect of reduced LVEV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion: In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality.",

author = "Washko, {George R.} and Pietro Nardelli and Ash, {Samuel Y.} and Rahaghi, {Farbod N.} and Sanchez-Ferrero, {Gonzalo Vegas} and Come, {Carolyn E.} and Dransfield, {Mark T.} and Ravi Kalhan and Han, {Mei Lan K.} and Bhatt, {Surya P.} and Wells, {J. Michael} and Pistenmaa, {Carrie L.} and Diaz, {Alejandro A.} and Ross, {James C.} and Stephen Rennard and Roca, {Gabriela Querejeta} and Shah, {Amil M.} and Kendra Young and Kinney, {Gregory L.} and Hokanson, {John E.} and Alvar Agust{\'i} and {Jos{\'e} Est{\'e}par}, {Ra{\'u}l San}",

note = "Publisher Copyright: {\textcopyright} RSNA, 2020.",

year = "2020",

month = jul,

doi = "10.1148/radiol.2020191793",

language = "English (US)",

volume = "296",

pages = "208--215",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America Inc.",

number = "1",

}

Washko, GR, Nardelli, P, Ash, SY, Rahaghi, FN, Sanchez-Ferrero, GV, Come, CE, Dransfield, MT, Kalhan, R, Han, MLK, Bhatt, SP, Wells, JM, Pistenmaa, CL, Diaz, AA, Ross, JC, Rennard, S, Roca, GQ, Shah, AM, Young, K, Kinney, GL, Hokanson, JE, Agustí, A & José Estépar, RS 2020, 'Smaller left ventricle size at noncontrast ct is associated with lower mortality in copdgene participants', Radiology, vol. 296, no. 1, pp. 208-215. https://doi.org/10.1148/radiol.2020191793

TY - JOUR

T1 - Smaller left ventricle size at noncontrast ct is associated with lower mortality in copdgene participants

AU - Washko, George R.

AU - Nardelli, Pietro

AU - Ash, Samuel Y.

AU - Rahaghi, Farbod N.

AU - Sanchez-Ferrero, Gonzalo Vegas

AU - Come, Carolyn E.

AU - Dransfield, Mark T.

AU - Kalhan, Ravi

AU - Han, Mei Lan K.

AU - Bhatt, Surya P.

AU - Wells, J. Michael

AU - Pistenmaa, Carrie L.

AU - Diaz, Alejandro A.

AU - Ross, James C.

AU - Rennard, Stephen

AU - Roca, Gabriela Querejeta

AU - Shah, Amil M.

AU - Young, Kendra

AU - Kinney, Gregory L.

AU - Hokanson, John E.

AU - Agustí, Alvar

AU - José Estépar, Raúl San

PY - 2020/7

Y1 - 2020/7

N2 - Background: Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose: To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LVEV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LVEV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods: The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LVEV, distal pulmonary venous blood volume for vessels smaller than 5 mm2 in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LVEV as well as the association of LVEV with health status using the St George’s Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results: The median age of the cohort was 64 years (interquartile range, 57–70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LVEV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men (P , .001 for both). In fully adjusted models, higher emphysema percentage (b = –4.2; 95% confidence interval [CI]: –5.0, 23.4; P , .001), venous BV5 (b = 7.0; 95% CI: 5.7, 8.2; P , .001), and pectoralis muscle area (b = 2.7; 95% CI: 1.2, 4.1; P , .001) were independently associated with reduced LVEV. Reductions in LVEV were associated with improved health status (b = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (b = –12.2; 95% CI: –15.2, –9.3). These effects were greater in women than in men. The effect of reduced LVEV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion: In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality.

AB - Background: Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose: To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LVEV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LVEV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods: The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LVEV, distal pulmonary venous blood volume for vessels smaller than 5 mm2 in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LVEV as well as the association of LVEV with health status using the St George’s Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results: The median age of the cohort was 64 years (interquartile range, 57–70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LVEV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men (P , .001 for both). In fully adjusted models, higher emphysema percentage (b = –4.2; 95% confidence interval [CI]: –5.0, 23.4; P , .001), venous BV5 (b = 7.0; 95% CI: 5.7, 8.2; P , .001), and pectoralis muscle area (b = 2.7; 95% CI: 1.2, 4.1; P , .001) were independently associated with reduced LVEV. Reductions in LVEV were associated with improved health status (b = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (b = –12.2; 95% CI: –15.2, –9.3). These effects were greater in women than in men. The effect of reduced LVEV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion: In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality.

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Smaller left ventricle size at noncontrast ct is associated with lower mortality in copdgene participants

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