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Incremental prognostic value of arterial elastance in mild-to-moderate idiopathic pulmonary fibrosis

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Abstract

Previous reports suggested that poor pulmonary function was associated with increased arterial elastance (Ea) in patients with chronic obstructive pulmonary disease and systemic sclerosis. The mechanisms connecting pulmonary function and Ea have not yet been accurately studied in patients with idiopathic pulmonary fibrosis (IPF). The present study was designed to assess Ea in IPF patients without chronic severe pulmonary hypertension and to determine its prognostic role over a medium-term follow-up. This retrospective study included 60 consecutive patients with mild-to-moderate IPF (73.8 ± 6.6 years, 75% males) and 60 controls matched by age, sex and cardiovascular risk factors. All patients underwent physical examination, spirometry, blood tests, modified Haller index (MHI, chest transverse diameter over the distance between sternum and spine) assessment, conventional transthoracic echocardiography implemented with speckle tracking analysis of left atrial positive global strain (LA-GSA+ ) and finally carotid Doppler ultrasonography, at basal evaluation. The effective arterial elastance index (EaI) was calculated as the ratio of end-systolic pressure to stroke volume index. During follow-up period, we evaluated the composite endpoint of (1) pulmonary or cardiovascular hospitalizations; (2) all-cause mortality. At baseline, EaI was significantly higher in IPF patients than controls (4.1 ± 1.3 vs 3.5 ± 1.0 mmHg/ml/m2, p = 0.01). EaI was strongly correlated to the following variables: C-reactive protein (CRP) (r = 0.86), forced vital capacity (FVC) (r =  − 0.91), E/e′ ratio (r = 0.91), LA-GSA+  (r =  − 0.92), common carotid artery-cross sectional area (CCA-CSA) (r = 0.89) and MHI (r = 0.86), in IPF patients. Mean follow-up time was 2.4 ± 1.3 years. During follow-up, 12 patients died and 17 were hospitalized due to major adverse clinical events. At univariate Cox analysis, CRP (HR 1.51, 95% CI 1.25–1.82), FVC (HR 0.88, 95% CI 0.85–0.91), LA-GSA+  (HR 0.85, 95% CI 0.77–0.94), CCA-CSA (HR 1.12, 95% CI 1.03–1.22) and EaI (HR 2.43, 95% CI 1.75–3.37) were significantly associated with outcome. At multivariate Cox analysis, only EaI (HR 1.60, 95% CI 1.03–2.50) retained statistical significance. An EaI ≥ 4 mmHg/ml/m2 showed 100% sensitivity and 99.4% specificity for predicting outcome (AUC = 0.98). In patients with mild-to-moderate IPF, an EaI ≥ 4 mmHg/ml/m2 is a negative prognostic factor over a medium-term follow-up.

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Abbreviations

6MWT:

Six-Minute Walking Test

AUC:

Area under curve

CCA:

Common carotid artery

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

CRP:

C-reactive protein

CSA:

Cross sectional area

DLCO:

Diffusing capacity of the lungs for carbon monoxide

EaI:

Arterial elastance index

EesI:

End-systolic elastance index

EDD:

End-diastolic diameter

eGFR:

Estimated glomerular filtration rate

ESP:

End-systolic pressure

FVC:

Forced vital capacity

GSA+  :

Positive global atrial strain

ICC:

Intraclass correlation coefficient

ILD:

Interstitial lung disease

IMT:

Intima–media thickness

IPF:

Idiopathic pulmonary fibrosis

LA:

Left atrial

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVESVi:

Left ventricular end-systolic volume index

MACE:

Major adverse clinical events

MHI:

Modified Haller index

ROC:

Receiver operating characteristic

RWT:

Relative wall thickness

SPAP:

Systolic pulmonary artery pressure

STE:

Speckle tracking echocardiography

SVi:

Stroke volume index

TRV:

Tricuspid regurgitation velocity

VAC:

Ventricular-arterial coupling

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Funding

This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.

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Authors and Affiliations

  1. Division of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Andrea Sonaglioni & Michele Lombardo

  2. Division of Pneumology, Semi-Intensive Care Unit, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Antonella Caminati & Sergio Harari

  3. Division of Cardiology, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy

    Gian Luigi Nicolosi

  4. Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy

    Sergio Harari

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  1. Andrea Sonaglioni
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  2. Antonella Caminati
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  5. Sergio Harari
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Contributions

AS: Conceptualization; Data curation; Investigation; Methodology; Software; Visualization; Writing—original draft. AC: Conceptualization; Data curation; Methodology; Writing—review & editing. GLN: Conceptualization; Supervision; Validation; Writing—review & editing. ML: Conceptualization; Supervision; Validation; Writing—review & editing. SH: Conceptualization; Supervision; Validation; Writing—review & editing.

Corresponding author

Correspondence to Antonella Caminati.

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Conflict of interest

We wish to confirm that there are no conflicts of interest associated with this publication. Andrea Sonaglioni declares that he has no conflict of interest. Antonella Caminati reports personal fees from Roche and Boehringer Ingelheim, outside the submitted work. Gian Luigi Nicolosi declares that he has no conflict of interest. Michele Lombardo declares that he has no conflict of interest. Sergio Harari reports grants and personal fees from Roche, Actelion and Boehringer Ingelheim, outside the submitted work.

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10554_2022_2541_MOESM1_ESM.docx

Supplemental table. Intra- and interobserver variability analysis of the main echoDoppler parameters and hemodynamic indices. ICC, intraclass correlation coefficient. CCA, common carotid artery. CI, confidence interval. CSA, cross sectional area. EaI, arterial elastance index. GSA+, positive global atrial strain. LA, left atrial (DOCX 21 KB)

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Sonaglioni, A., Caminati, A., Nicolosi, G.L. et al. Incremental prognostic value of arterial elastance in mild-to-moderate idiopathic pulmonary fibrosis. Int J Cardiovasc Imaging 38, 1473–1485 (2022). https://doi.org/10.1007/s10554-022-02541-y

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