Relationship of Lung Function and the Preserved Ratio Impaired Spirometry Pattern with Aortic and Left Ventricular Structure and Function on Magnetic Resonance Imaging: The Jackson Heart Study.

Abstract

Introduction: Low lung function and Preserved Ratio Impaired Spirometry (PRISm) have been associated with increased co-morbid cardiovascular disease. However, the association of abnormal lung function and PRISm with imaging markers of cardiovascular dysfunction has not been well elucidated.

Methods: Participants from the Jackson Heart Study who had spirometry measurements at baseline and underwent cardiac magnetic resonance (CMR) were included. Multivariable adjusted associations between forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) and markers of aortic (pulse wave velocity, aPWV, wall thickness) and cardiac function (left ventricular (LV) stroke volume, and indexed LV mass) as measured on CMR were examined using linear regression models. Study participants were then divided into three groups (normal spirometry: FEV1/FVC ≥ 0.70, FEV1 ≥ 80%, airflow obstruction: FEV1/FVC < 0.70, and PRISm: FEV1/FVC ≥ 0.70, FEV1 < 80%). We then examined the associations of spirometry pattern and markers of structure and function as dichotomous outcomes using multivariable adjusted logistic regression models.

Results: A total of 1278 participants (788 women [63%]; 375 (29%) ever smokers, 612 (48%) with hypertension, 1033 [81%] with normal spirometry, 80 [6%] with airflow obstruction, and 165 (13%) with PRISm met criteria for inclusion. In a multivariable model adjusting for age, sex, BMI, smoking status, and systolic blood pressure, aPWV was significantly associated with FEV1% (-0.20 ± 0.03, p = 0.04) and those with airflow obstruction had significantly higher odds of an increased aPWV (OR 2.25, 95% CI 1.29-3.93) compared to controls with a normal spirometry pattern. In the multivariable adjusted model, those with PRISm had a higher likelihood of a reduced LV stroke volume compared to controls (OR 1.69, 95% CI 1.14-2.56).

Discussion: The PRISm pattern is associated with decreased LV stroke volume. This may be a potential mechanism between PRISm pattern and incident heart failure.