估计的心室大小，哮喘严重程度和急性发作：SARP III队列
2019/10/17
摘要
背景：COPD或囊性纤维化患者CT影像上肺动脉（PA）相对增宽与呼吸道恶化相关。我们试图确定在哮喘患者中是否存在类似的发现，以及是否通过心室大小的差异来解释这种现象。
方法：我们测量了来自重症哮喘研究计划III队列的233患者的肺动脉和主动脉直径。同时评估了右心室、左心室和全心室心外膜心室容积指数（分别为eERVVI，eELVVI和eETVVI）。使用Pearson相关性评估了心脏和PA测量值（PA与主动脉的比率（PA / A），eERVVI与eELVVI的比率（eRV / eLV），eERVVI，eELVVI，eETVVI）与哮喘严重程度的临床指标之间的关系，以及利用多变量线性和零膨胀负二项式回归评估哮喘严重程度与急性加重比率相关性。
结果：哮喘的严重程度与较小的心室容积有关。例如，重症哮喘患者的eETVVI较健康对照者低36.1mL/m2（p = 0.003），eETVVI较轻度/中度疾病（e = 0.011）低14.1mL/m2。回顾性和前瞻性研究显示，较小的心室容量也与哮喘较高急性发生率相关。例如，eETVVI小于中位数的患者在随访期间的急性发作发生率比eETVVI大于中位数的患者高57％（p = 0.020）。PA/A及eRV/eLV均与哮喘的严重程度或急性加重无相关性。
结论：在哮喘患者中，较小的心室面积可能与更严重的疾病程度和更高的哮喘急性发作率相关。
Estimated Ventricular Size, Asthma Severity and Exacerbations: The SARP III Cohort.
Ash SY, Vegas Sanchez-Ferrero G, Schiebler ML, Rahaghi FN, Rai A, Come CE, Ross JC, Colon AG, Cardet JC, Bleecker ER, Castro M,Fahy JV, Fain SB, Gaston BM, Hoffman EA, Jarjour NN, Lempel JK, Mauger DT, Tattersall MC, Wenzel SE, Levy BD, Washko GR, Israel E, San Jose Estepar R; SARP Investigators.
Abstract
BACKGROUND: Relative enlargement of the pulmonary artery (PA) on chest computed tomography (CT) is associated with respiratory exacerbations in patients with chronic obstructive pulmonary disease or cystic fibrosis. We sought to determine if similar findings were present in patients with asthma and if they were explained by differences in ventricular size.
METHODS: We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI and eETVVI respectively). Associations between the cardiac and PA measures (PA to aorta ratio (PA/A), eERVVI to eELVVI ratio (eRV/eLV), eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed using Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated using multivariable linear and zero-inflated negative binomial regression.
RESULTS: Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m2 smaller eETVVI than healthy controls (p=0.003) and 14.1 mL/m2 smaller eETVVI than those with mild/moderate disease (p=0.011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example,those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow up than those with eETVVI greater than the median(p=0.020). Neither PA/A nor eRV/eLV were associated with asthma severity or exacerbations.
CONCLUSIONS: In asthmatics, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations.
背景：COPD或囊性纤维化患者CT影像上肺动脉（PA）相对增宽与呼吸道恶化相关。我们试图确定在哮喘患者中是否存在类似的发现，以及是否通过心室大小的差异来解释这种现象。
方法：我们测量了来自重症哮喘研究计划III队列的233患者的肺动脉和主动脉直径。同时评估了右心室、左心室和全心室心外膜心室容积指数（分别为eERVVI，eELVVI和eETVVI）。使用Pearson相关性评估了心脏和PA测量值（PA与主动脉的比率（PA / A），eERVVI与eELVVI的比率（eRV / eLV），eERVVI，eELVVI，eETVVI）与哮喘严重程度的临床指标之间的关系，以及利用多变量线性和零膨胀负二项式回归评估哮喘严重程度与急性加重比率相关性。
结果：哮喘的严重程度与较小的心室容积有关。例如，重症哮喘患者的eETVVI较健康对照者低36.1mL/m2（p = 0.003），eETVVI较轻度/中度疾病（e = 0.011）低14.1mL/m2。回顾性和前瞻性研究显示，较小的心室容量也与哮喘较高急性发生率相关。例如，eETVVI小于中位数的患者在随访期间的急性发作发生率比eETVVI大于中位数的患者高57％（p = 0.020）。PA/A及eRV/eLV均与哮喘的严重程度或急性加重无相关性。
结论：在哮喘患者中，较小的心室面积可能与更严重的疾病程度和更高的哮喘急性发作率相关。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Chest. 2019 Sep 12. pii: S0012-3692(19)33744-4. doi:10.1016/j.chest.2019.08.2185.）
（Chest. 2019 Sep 12. pii: S0012-3692(19)33744-4. doi:10.1016/j.chest.2019.08.2185.）
Estimated Ventricular Size, Asthma Severity and Exacerbations: The SARP III Cohort.
Ash SY, Vegas Sanchez-Ferrero G, Schiebler ML, Rahaghi FN, Rai A, Come CE, Ross JC, Colon AG, Cardet JC, Bleecker ER, Castro M,Fahy JV, Fain SB, Gaston BM, Hoffman EA, Jarjour NN, Lempel JK, Mauger DT, Tattersall MC, Wenzel SE, Levy BD, Washko GR, Israel E, San Jose Estepar R; SARP Investigators.
Abstract
BACKGROUND: Relative enlargement of the pulmonary artery (PA) on chest computed tomography (CT) is associated with respiratory exacerbations in patients with chronic obstructive pulmonary disease or cystic fibrosis. We sought to determine if similar findings were present in patients with asthma and if they were explained by differences in ventricular size.
METHODS: We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI and eETVVI respectively). Associations between the cardiac and PA measures (PA to aorta ratio (PA/A), eERVVI to eELVVI ratio (eRV/eLV), eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed using Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated using multivariable linear and zero-inflated negative binomial regression.
RESULTS: Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m2 smaller eETVVI than healthy controls (p=0.003) and 14.1 mL/m2 smaller eETVVI than those with mild/moderate disease (p=0.011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example,those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow up than those with eETVVI greater than the median(p=0.020). Neither PA/A nor eRV/eLV were associated with asthma severity or exacerbations.
CONCLUSIONS: In asthmatics, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations.
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