Association between emphysema-like lung on cardiac computed tomography and mortality in persons without airflow obstruction: a cohort study

Elizabeth C Oelsner; Eric A Hoffman; Aaron R Folsom; J Jeffrey Carr; Paul L Enright; Steven M Kawut; Richard Kronmal; David Lederer; Joao A C Lima; Gina S Lovasi; Steven Shea; R Graham Barr

doi:10.7326/M13-2570

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Association between emphysema-like lung on cardiac computed tomography and mortality in persons without airflow obstruction: a cohort study

Journal article

Peer reviewed

Association between emphysema-like lung on cardiac computed tomography and mortality in persons without airflow obstruction: a cohort study

Elizabeth C Oelsner, Eric A Hoffman, Aaron R Folsom, J Jeffrey Carr, Paul L Enright, Steven M Kawut, Richard Kronmal, David Lederer, Joao A C Lima, Gina S Lovasi, …

Annals of internal medicine, Vol.161(12), pp.863-U54

12/16/2014

DOI: 10.7326/M13-2570

PMCID: PMC4347817

PMID: 25506855

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Abstract

Low lung function is known to predict mortality in the general population, but the prognostic significance of emphysema on computed tomography (CT) in persons without chronic obstructive pulmonary disease (COPD) is uncertain. To determine whether greater emphysema-like lung on CT is associated with all-cause mortality among persons in the general population without airflow obstruction or COPD. Prospective cohort study. Population-based, multiethnic sample from 6 U.S. communities. 2965 participants aged 45 to 84 years without airflow obstruction on spirometry. Emphysema-like lung was defined as the number of lung voxels with attenuation less than -950 Hounsfield units on cardiac CT and was adjusted for the number of total imaged lung voxels. Among 2965 participants, 50.9% of whom had never smoked, there were 186 deaths over a median of 6.2 years. Greater emphysema-like lung was independently associated with increased mortality (adjusted hazard ratio per one-half interquartile range, 1.14 [95% CI, 1.04 to 1.24]; P=0.004) after adjustment for potential confounders, including cardiovascular risk factors and FEV1. Generalized additive models supported a linear association between emphysema-like lung and mortality without evidence for a threshold. The association was of greatest magnitude among smokers, although multiplicative interaction terms did not support effect modification by smoking status. Cardiac CT scans did not include lung apices. The number of deaths was limited among subgroup analyses. Emphysema-like lung on CT was associated with all-cause mortality among persons without airflow obstruction or COPD in a general population sample, particularly among smokers. Recognition of the independent prognostic significance of emphysema on CT among patients without COPD on spirometry is warranted. National Heart, Lung, and Blood Institute.

Smoking - adverse effects

Pulmonary Emphysema - complications

Spirometry

Pulmonary Emphysema - physiopathology

Prospective Studies

Pulmonary Ventilation

Humans

Middle Aged

Mortality

Risk Factors

Tomography, X-Ray Computed - methods

Male

Lung - diagnostic imaging

Lung - physiopathology

Pulmonary Emphysema - diagnostic imaging

Heart - diagnostic imaging

Lung Volume Measurements

Aged, 80 and over

Female

Aged

Tomography, X-Ray Computed - instrumentation

Details

Title: Subtitle: Association between emphysema-like lung on cardiac computed tomography and mortality in persons without airflow obstruction: a cohort study
Creators: Elizabeth C Oelsner
Eric A Hoffman
Aaron R Folsom
J Jeffrey Carr
Paul L Enright
Steven M Kawut
Richard Kronmal
David Lederer
Joao A C Lima
Gina S Lovasi
Steven Shea
R Graham Barr
Resource Type: Journal article
Publication Details: Annals of internal medicine, Vol.161(12), pp.863-U54
DOI: 10.7326/M13-2570
PMID: 25506855
PMCID: PMC4347817
NLM abbreviation: Ann Intern Med
ISSN: 0003-4819
eISSN: 1539-3704
Publisher: United States
Grant note: N01HC95169 / NHLBI NIH HHS P30 ES009089 / NIEHS NIH HHS R01-93081 / PHS HHS N01-HC-95169 / NHLBI NIH HHS RC1 HL100543 / NHLBI NIH HHS N01HC95159 / NHLBI NIH HHS R01 HL103676 / NHLBI NIH HHS N01-HC-95166 / NHLBI NIH HHS R01 HL077612 / NHLBI NIH HHS N01-HC-95163 / NHLBI NIH HHS K24 HL103844 / NHLBI NIH HHS RC1-100543 / CCR NIH HHS N01-HC-95165 / NHLBI NIH HHS UL1 RR025005 / NCRR NIH HHS N01-HC-95168 / NHLBI NIH HHS N01-HC-95160 / NHLBI NIH HHS UL1-RR-025005 / NCRR NIH HHS R01 HL093081 / NHLBI NIH HHS R01 HL112986 / NHLBI NIH HHS N01-HC-95162 / NHLBI NIH HHS R01-HL077612 / NHLBI NIH HHS UL1-RR-024156 / NCRR NIH HHS N01-HC-95159 / NHLBI NIH HHS UL1 RR024156 / NCRR NIH HHS N01-HC-95161 / NHLBI NIH HHS N01-HC-95167 / NHLBI NIH HHS N01-HC-95164 / NHLBI NIH HHS
Language: English
Date published: 12/16/2014
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984051990502771

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