{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:41:18Z","timestamp":1783690878644,"version":"3.55.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["NO1-HC-25195, HHSN268201500001I, 75N92019D00031, 1 R01HL132320, 1R01HL131029, R01HL131015, R01 HL086875, 5T32HL125232"],"award-info":[{"award-number":["NO1-HC-25195, HHSN268201500001I, 75N92019D00031, 1 R01HL132320, 1R01HL131029, R01HL131015, R01 HL086875, 5T32HL125232"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Evans Scholar award and Jay and Louise Coffman endowment, Department of Medicine, Boston University School of Medicine"},{"name":"Cardiovascular Engineering., Inc."}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Lung function abnormalities are ubiquitous in heart failure (HF). It is unclear, however, if abnormal lung diffusion capacity is associated with cardiac remodeling and antedates HF. We hypothesized that lower lung diffusion capacity for carbon monoxide (DLCO) is associated with worse left ventricular (LV) systolic and diastolic function cross-sectionally, and with higher risk of HF prospectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We evaluated 2423 Framingham Study participants (mean age 66 years, 55% women) free of HF who underwent routine echocardiography and pulmonary function tests. We used multivariable regression models to relate DLCO, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) to left ventricular ejection fraction (LVEF), left atrial (LA) emptying fraction (LAEF), E\/e\u2019, E\/A, LV mass, and LA diameter (LAD). Multivariable-adjusted Cox proportional hazards regression was used to relate DLCO, FEV1, and FVC to incident HF.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In multivariable-adjusted cross-sectional analyses, DLCO, FEV1, and FVC (dependent variables) were associated positively with LVEF (\u03b2<jats:sub>DLCO<\/jats:sub> = 0.208, \u03b2<jats:sub>FEV1<\/jats:sub> = 0.021, and \u03b2<jats:sub>FVC<\/jats:sub> = 0.025 per 5% increment in LVEF; p&lt;0.005 for all), and LAEF (\u03b2<jats:sub>DLCO<\/jats:sub> = 0.707, \u03b2<jats:sub>FEV1<\/jats:sub> = 0.058 and \u03b2<jats:sub>FVC<\/jats:sub> = 0.058 per 5% increment in LAEF; p&lt;0.002 for all). DLCO and FVC were inversely related to E\/A (\u03b2<jats:sub>DLCO<\/jats:sub> = -0.289, \u03b2<jats:sub>FVC<\/jats:sub> = -0.047 per SD increment in E\/A; p&lt;0.001 for all). Additionally, DLCO, FEV1 and FVC were inversely related to HF risk (108 events, median follow-up 9.7 years; multivariable-adjusted hazard ratios per SD increment 0.90, 95% CI 0.86\u20130.95; 0.42, 95% CI 0.28\u20130.65, and 0.51, 95% CI 0.36\u20130.73, respectively). These results remained robust in analyses restricted to non-smokers.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our large community-based observations are consistent with the concept that lower lung diffusion capacity and expiratory flow rates are associated with cardiac remodeling and may antedate HF. Additional studies are needed to confirm our findings and to evaluate the prognostic utility of pulmonary function testing for predicting HF.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0246355","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T21:32:10Z","timestamp":1613511130000},"page":"e0246355","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of lung diffusion capacity with cardiac remodeling and risk of heart failure: The Framingham heart study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2898-9792","authenticated-orcid":true,"given":"Ibrahim Musa","family":"Yola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4211-3113","authenticated-orcid":true,"given":"Albin","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary F.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"O\u2019Connor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4977-036X","authenticated-orcid":true,"given":"Susan","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7357-5970","authenticated-orcid":true,"given":"Ramachandran S.","family":"Vasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-621X","authenticated-orcid":true,"given":"Vanessa","family":"Xanthakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"key":"pone.0246355.ref001","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1161\/CIR.0000000000000558","article-title":"Heart disease and stroke statistics\u20142018 update: a report from the American Heart Association","volume":"137","author":"EJ Benjamin","year":"2018","journal-title":"Circulation"},{"key":"pone.0246355.ref002","article-title":"Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community","author":"CS Lam","year":"2011","journal-title":"Circulation"},{"key":"pone.0246355.ref003","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.cardfail.2008.06.004","article-title":"Alveolar gas diffusion abnormalities in heart failure","volume":"14","author":"M. 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