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

Lagan LEKARZ, 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; Quint, Jennifer K.; Barraclough, Richard; Schmitt, Matthias; Miller, Christopher A.

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Authors

Jakub Lagan LEKARZ

Erik B. Schelbert

Josephine H. Naish

Jørgen Vestbo

Christien Fortune

Joshua Bradley

Edward Hearne

Foluwakemi Ogunyemi

Richard Timoney

Daniel Prescott

Hamish D.C. Bain

Tasneem Bangi

Mahvash Zaman

Christopher Wong

Anthony Ashworth

Helen Thorpe

Robin Egdell

Jerome McIntosh

Bruce R. Irwin

David Clark

Graham Devereux

Jennifer K. Quint

Richard Barraclough

Matthias Schmitt

Christopher A. Miller



Abstract

OBJECTIVES: 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. BACKGROUND: COPD is associated with HF independent of shared risk factors. The underlying pathophysiological mechanism is unknown. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Journal Article Type Article
Acceptance Date Mar 19, 2021
Online Publication Date May 19, 2021
Publication Date 2021-10
Publicly Available Date May 30, 2023
Journal JACC: Cardiovascular Imaging
Print ISSN 1936-878X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 14
Issue 10
Pages 1963-1973
DOI https://doi.org/10.1016/j.jcmg.2021.03.026
Publisher URL https://publications.keele.ac.uk/viewobject.html?cid=1&id=173717

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