Active Tobacco Smoking Impairs Cardiac Systolic Function

Tom Hendriks,Randy Van Dijk,Najod A Alsabaan,Pim Van Der Harst

doi:10.1038/s41598-020-63509-3

Abstract

Tobacco smoking is a well-established risk factor for cardiovascular disease, but its direct effect on myocardial structure and function remains unclear. This study investigated the effects of smoking using a nested matched case-control study design. 5,668 participants of the UK Biobank study who underwent cardiovascular magnetic resonance imaging were screened for inclusion. 102 smokers (56 males) with a median age of 56 years were matched to non-smokers based on sex, age, and body surface area. Manual post-processing and feature tracking analyses were performed to determine left ventricular (LV) and right ventricular (RV) structure and function measures. Linear regression analyses were performed to determine the effect of tobacco smoking on imaging measures. Tobacco smoking was associated with increased LV and RV end-systolic volume (4.98 ± 2.08 mL, 5.19 ± 2.62 mL, P = 0.018, 0.049 respectively), reduced LV and RV ejection fraction (β: −2.21 ± 0.82%, −2.06 ± 0.87%, P = 0.007, 0.019 respectively), and reduced absolute measures of LV peak global longitudinal, radial, and circumferential strain (β: 0.86 ± 0.30%, −2.52 ± 0.99%, 1.05 ± 0.32%, P = 0.004, 0.011, 0.001 respectively). Effect sizes were larger in daily smokers compared to occasional smokers. In a general Caucasian population without known clinical cardiovascular disease, active tobacco smoking was dose dependently associated with impaired cardiac systolic function.

Highlights

Tobacco smoking is associated with an increased incidence of cardiovascular diseases, including myocardial infarction, vascular stroke, peripheral artery disease, and heart failure[1,2,3]
Large epidemiological studies focusing on the effects of cardiac risk factors on cardiac structure and function indicate an association of tobacco smoking with increased left ventricular (LV) mass and reduced LV systolic function[5,6,7,8]
Active tobacco smoking was a significant predictor of impaired LV and right ventricular (RV) systolic function, with regard to EF (β: −2.21 ± 0.82%, −2.06 ± 0.87%, P = 0.007, 0.019 respectively) as well as LV myocardial peak global longitudinal strain (GLS), peak global radial strain (GRS) and peak global circumferential strain (GCS) (β: 0.86 ± 0.30%, −2.52 ± 0.99%, 1.05 ± 0.32%, P = 0.004, 0.011, 0.001 respectively), both in univariate linear regression analyses and after further adjustment for matching parameters and possible confounders

Summary

Introduction

Tobacco smoking is associated with an increased incidence of cardiovascular diseases, including myocardial infarction, vascular stroke, peripheral artery disease, and heart failure[1,2,3]. Large epidemiological studies focusing on the effects of cardiac risk factors on cardiac structure and function indicate an association of tobacco smoking with increased left ventricular (LV) mass and reduced LV systolic function[5,6,7,8]. Cardiovascular magnetic resonance imaging (CMR) is the gold standard for both structural and functional cardiac assessment, as well as tissue characterization[11]. The aim of our study was to determine the effects of tobacco smoking on cardiac structure and function using CMR as the imaging modality of choice

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Discussion

Conclusion