Morphological and Clinicopathological Correlates Of Cor Pulmonale in Pulmonary Emphysema: An Anatomical Assessment

Abstract

Background: Pulmonary emphysema is characterized by irreversible destruction of alveolar walls and loss of the pulmonary capillary bed. Progressive pulmonary vascular abnormalities, hypoxic vasoconstriction, and increased pulmonary vascular resistance may impose chronic pressure overload on the right ventricle, resulting in right ventricular hypertrophy and, in advanced disease, cor pulmonale.

Objective: To assess the morphological and clinicopathological correlates of cor pulmonale in individuals with pulmonary emphysema, with emphasis on emphysema pattern, pulmonary vascular abnormalities, right ventricular hypertrophy, and selected clinical and pathological characteristics.

Methods: This analytical observational study included 160 individuals with histologically confirmed pulmonary emphysema. Clinical records and available cardiopulmonary findings were reviewed, followed by systematic gross and microscopic examination of pulmonary and cardiac specimens. Emphysema was classified as centrilobular, panlobular, paraseptal, or mixed. Pulmonary vascular abnormalities included vascular deformity, arteriolar narrowing, medial hypertrophy, intimal fibrosis, vascular compression, and thromboembolic lesions. Cor pulmonale was defined anatomically by right ventricular hypertrophy with or without right ventricular dilatation in the setting of pulmonary disease after exclusion of a primary left-sided cardiac cause.

Results: Cor pulmonale was identified in 118/160 (73.8%). Right ventricular hypertrophy was most frequent in mixed and centrilobular emphysema. Pulmonary vascular deformity, vascular compression, intimal fibrosis, and arteriolar narrowing were frequent and were more common among cases with cor pulmonale. Extensive emphysema and several pulmonary vascular abnormalities showed independent associations with cor pulmonale in the multivariable model.

Conclusion: Cor pulmonale in pulmonary emphysema appears to reflect combined parenchymal destruction, pulmonary vascular remodeling/deformation, and right ventricular adaptation. Integrated cardiopulmonary morphological assessment may improve understanding of the structural basis of right-sided cardiac remodeling.