Cardiac alterations related to new CT emphysema subtypes: results from the SubPopulations and InteRmediate Outcome Measures In COPD and Heart Failure Study (SPIROMICS HF)

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Background: Chronic obstructive pulmonary disease (COPD) and heart failure often overlap clinically. We tested if new emphysema subtypes defined by unsupervised machine learning on computed tomography (CT) were associated with specific cardiac alterations. Methods: SPIROMICS HF is a multicenter observational study of cardiopulmonary interactions among smokers with >20 packyears and controls. This preliminary report explored associations between the 2 main CT emphysema subtypes in SPIROMICS, the combined bronchitic-apical emphysema (CBaE) and diffuse emphysema subtypes, and cardiac size and function, assessed on echocardiography and cardiac MRIs. Results were adjusted for demographics, height, weight, smoking, recruitment strata and other CT emphysema subtypes. Results: Among 529 participants (mean age 68 years, 52% male, 30% currently smoking, mean packyears 44.9 and 61.1% with COPD), CBeE and diffuse emphysema were labelled in 14.6% and 29.2% of the lung, respectively. Degree of CBaE was associated with higher pulmonary artery systolic pressure (PASP) (1.7 mmHg/10%; 95% CI 0.5-2.9; P=0.006) and greater right/left ventricle (LV) mass ratio (0.01/10%, 0.00-0.02, P=0.02) without a difference in LV stroke volume (P=0.54). Degree of diffuse emphysema was associated with lower LV stroke volume (−4.3 ml/10%; -6.3, -2.2; P<0.001) without a difference in PASP (P=0.24). Conclusion: Of the two main CT-defined emphysema subtypes, one was associated with greater PASP and evidence for cor pulmonale whereas the other was associated with lower LV function, findings reminiscent of the classic blue bloater and pink puffer COPD subtypes.

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