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Mechanisms Underlying the Association of Chronic Obstructive Pulmonary Disease With Heart Failure

Lagan, Jakub, Schelbert, Erik B., Naish, Josephine H., Vestbo, Jørgen, Fortune, Christien, Bradley, Joshua, Belcher, John, Hearne, Edward, Ogunyemi, Foluwakemi, Timoney, Richard, Prescott, Daniel, Bain, Hamish D.C., Bangi, Tasneem, Zaman, Mahvash, Wong, Christopher, Ashworth, Anthony, Thorpe, Helen, Egdell, Robin, McIntosh, Jerome, Irwin, Bruce R., Clark, David, Devereux, Graham ORCID:, Quint, Jennifer K., Barraclough, Richard, Schmitt, Matthias and Miller, Christopher A. (2021) 'Mechanisms Underlying the Association of Chronic Obstructive Pulmonary Disease With Heart Failure'. JACC: Cardiovascular Imaging, Vol 14, Issue 10, pp. 1963-1973.

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The purposes of this study were to determine why chronic obstructive pulmonary disease (COPD) is associated with heart failure (HF). Specific objectives included whether COPD is associated with myocardial fibrosis, whether myocardial fibrosis is associated with hospitalization for HF and death in COPD, and whether COPD and smoking are associated with myocardial inflammation.

COPD is associated with HF independent of shared risk factors. The underlying pathophysiological mechanism is unknown.

A prospective, multicenter, longitudinal cohort study of 572 patients undergoing cardiac magnetic resonance (CMR), including 450 patients with COPD and 122 age- and sex-matched patients with a median: 726 days (interquartile range: 492 to 1,160 days) follow-up. Multivariate analysis was used to examine the relationship between COPD and myocardial fibrosis, measured using cardiac magnetic resonance (CMR). Cox regression analysis was used to examine the relationship between myocardial fibrosis and outcomes; the primary endpoint was composite of hospitalizations for HF or all-cause mortality; secondary endpoints included hospitalizations for HF and all-cause mortality. Fifteen patients with COPD, 15 current smokers, and 15 healthy volunteers underwent evaluation for myocardial inflammation, including ultrasmall superparamagnetic particles of iron oxide CMR.

COPD was independently associated with myocardial fibrosis (p < 0.001). Myocardial fibrosis was independently associated with the primary outcome (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.08 to 1.20; p < 0.001), hospitalization for HF (HR: 1.25 [95% CI: 1.14 to 1.36]); p < 0.001), and all-cause mortality. Myocardial fibrosis was associated with outcome measurements more strongly than any other variable. Acute and stable COPD were associated with myocardial inflammation.

The associations between COPD, myocardial inflammation and myocardial fibrosis, and the independent prognostic value of myocardial fibrosis elucidate a potential pathophysiological link between COPD and HF.

Item Type: Article
Subjects: QZ Pathology > Manifestations of Disease > QZ 140 General manifestations of disease
WF Respiratory System > Lungs > WF 600 Lungs
WG Cardiovascular System > WG 120 Cardiovascular diseases
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 24 May 2021 10:12
Last Modified: 20 Oct 2021 11:54


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