Estimated Cardiac Hemodynamics using Cardiac Magnetic Resonance Imaging (MRI) and Computed Tomography Emphysema Subtypes (CTES): The Multi-Ethnic Study of Atherosclerosis (MESA) Chronic Obstructive Pulmonary Disease (COPD) Study

<bold>Background:</bold> Pulmonary hypertension (PH) is a complication of COPD and emphysema. Contemporary subphenotypes of COPD at risk for PH is unclear. <bold>Aim:</bold> To investigate the association between estimated cardiac hemodynamics on cardiac MRI and CTES in a community-based sample with and without COPD. <bold>Methods:</bold> MESA COPD is a nested COPD case-control study of participants aged 50–79 with ≥10 packyear smoking history without cardiovascular disease. Participants underwent spirometry, lung CT and cardiac MRI. CTES were labeled by an unsupervised machine learning model validated in an independent sample. Estimated mean pulmonary artery pressure (ePAP), pulmonary arterial wedge pressure (ePAWP), and pulmonary vascular resistance (ePVR) were calculated using validated equations on cardiac MRI. Adjusted linear regression models were used to evaluate the relationship between CTES and estimated hemodynamics. <bold>Results:</bold> The 301 participants were 68±7 years old, 60% male, 28% currently smoking, and 145 participants had COPD (42% mild, 45% moderate and 13% severe). The combined bronchitic-apical emphysema subtype was associated with greater ePAP (1.08 mmHg per 10% increment, 95% CI 0.40, 1.75). The diffuse subtype was associated with lower ePAWP (−0.49 mmHg per 10% increment, 95% CI -0.75, -0.24) and greater ePVR (0.36 Wood units per 10% increment, 95% CI: 0.10, 0.61). <bold>Conclusions:</bold> Greater ePAP was specific to combined bronchitic-apical emphysema; greater ePVR was associated with diffuse emphysema. Precision emphysema phenotyping may inform risk stratification for PH in COPD.