TOPLINE

Structural remodeling of pulmonary arteries among community-dwelling older adults was associated with worse left ventricular (LV) function, higher pulmonary artery systolic pressure (PASP), and an increased risk for heart failure (HF) over 4 years.

METHODOLOGY

• Researchers conducted a prospective cohort analysis of 2275 participants from the Atherosclerosis Risk in Communities (ARIC) study who underwent echocardiography and non-contrast cardiac CT during the 2018-2019 study visit.
• Participants had a mean age of 80 years; 61% were women, 22% reported Black race, and mean LV ejection fraction (LVEF) was 64%.
• Investigators quantified pulmonary vascular arterial (PVa) remodeling using CT-derived measures of total pulmonary vascular area comprised of arterial vessels with cross-sectional area < 5 mm² (aBV5/aTBV, reflecting distal pruning) and arterial vessels with cross-sectional area > 10 mm² (aBVg10/aTBV, reflecting proximal dilation).
• Multivariable linear regression models, adjusted for demographics and cardiovascular risk factors, assessed associations of aBV5/aTBV and aBVg10/aTBV with echocardiographic measures of cardiac structure and function, PASP, circulating NT-proBNP, self-reported dyspnea, and incident HF over 4-year follow-up.

TAKEAWAY

• Mean aBV5/aTBV was 0.30 and mean aBVg10/aTBV was 0.45; greater distal pruning (lower aBV5/aTBV) and greater proximal dilation (higher aBVg10/aTBV) were both associated with greater LV remodeling, worse diastolic function, and worse systolic function.
• Both pulmonary vascular remodeling measures demonstrated nonlinear associations with greater PASP.
• Lower aBV5/aTBV and higher aBVg10/aTBV were associated with higher circulating NT-proBNP levels and increased odds of moderate-to-severe dyspnea.
• Higher aBVg10/aTBV was associated with greater risk for incident HF over 4-year follow-up (hazard ratio, 1.25; 95% CI, 1.03-1.51 per 1-SD increase).

IN PRACTICE

"Together, these findings suggest that cardiac dysfunction and remodeling in advanced age is associated with pulmonary vascular remodeling which may occur prior to clinical pulmonary hypertension and HF," the authors wrote.

SOURCE

The study was led by Aditya Dewanjee, MD, University of Texas Southwestern Medical Center, Dallas. It was published online on July 21 in Circulation.

LIMITATIONS

The study's observational design limited causal inference. The cohort consisted primarily of older adults, which may limit generalizability to younger populations. The analysis relied on single timepoint imaging.

DISCLOSURES

No specific funding was reported. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.