Pulmonary Arterial Pruning and Longitudinal Change in Percent Emphysema and Lung Function: The Genetic Epidemiology of COPD Study

Carrie L Pistenmaa; P Nardelli; S Y Ash; C E Come; A A Diaz; F N Rahaghi; R G Barr; K A Young; G L Kinney; J P Simmons; R C Wade; J M Wells; J E Hokanson; G R Washko; R San José Estépar; COPDGene Investigators

doi:10.1016/j.chest.2021.01.084

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Pulmonary Arterial Pruning and Longitudinal Change in Percent Emphysema and Lung Function: The Genetic Epidemiology of COPD Study

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Pulmonary Arterial Pruning and Longitudinal Change in Percent Emphysema and Lung Function: The Genetic Epidemiology of COPD Study

Carrie L Pistenmaa, P Nardelli, S Y Ash, C E Come, A A Diaz, F N Rahaghi, R G Barr, K A Young, G L Kinney, J P Simmons, …

Chest, Vol.160(2), pp.470-480

08/2021

DOI: 10.1016/j.chest.2021.01.084

PMCID: PMC8411454

PMID: 33607083

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Abstract

Pulmonary endothelial damage has been shown to precede the development of emphysema in animals, and vascular changes in humans have been observed in COPD and emphysema. Is intraparenchymal vascular pruning associated with longitudinal progression of emphysema on CT imaging or decline in lung function over 5 years? The Genetic Epidemiology of COPD Study enrolled ever smokers with and without COPD from 2008 through 2011. The percentage of emphysema-like lung, or "percent emphysema," was assessed at baseline and after 5 years on noncontrast CT imaging as the percentage of lung voxels < -950 Hounsfield units. An automated CT imaging-based tool assessed and classified intrapulmonary arteries and veins. Spirometry measures are postbronchodilator. Pulmonary arterial pruning was defined as a lower ratio of small artery volume (< 5 mm cross-sectional area) to total lung artery volume. Mixed linear models included demographics, anthropomorphics, smoking, and COPD, with emphysema models also adjusting for CT imaging scanner and lung function models adjusting for clinical center and baseline percent emphysema. At baseline, the 4,227 participants were 60 ± 9 years of age, 50% were women, 28% were Black, 47% were current smokers, and 41% had COPD. Median percent emphysema was 2.1 (interquartile range, 0.6-6.3) and progressed 0.24 percentage points/y (95% CI, 0.22-0.26 percentage points/y) over 5.6 years. Mean FEV to FVC ratio was 68.5 ± 14.2% and declined 0.26%/y (95% CI, -0.30 to -0.23%/y). Greater pulmonary arterial pruning was associated with more rapid progression of percent emphysema (0.11 percentage points/y per 1-SD increase in arterial pruning; 95% CI, 0.09-0.16 percentage points/y), including after adjusting for baseline percent emphysema and FEV . Arterial pruning also was associated with a faster decline in FEV to FVC ratio (-0.04%/y per 1-SD increase in arterial pruning; 95% CI, -0.008 to -0.001%/y). Pulmonary arterial pruning was associated with faster progression of percent emphysema and more rapid decline in FEV to FVC ratio over 5 years in ever smokers, suggesting that pulmonary vascular differences may be relevant in disease progression. ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.

Disease Progression

Endothelium, Vascular - diagnostic imaging

Endothelium, Vascular - pathology

Female

Humans

Longitudinal Studies

Male

Middle Aged

Pulmonary Artery - diagnostic imaging

Pulmonary Artery - pathology

Pulmonary Disease, Chronic Obstructive - diagnostic imaging

Pulmonary Disease, Chronic Obstructive - genetics

Pulmonary Disease, Chronic Obstructive - physiopathology

Respiratory Function Tests

Smokers

Tomography, X-Ray Computed

Details

Title: Subtitle: Pulmonary Arterial Pruning and Longitudinal Change in Percent Emphysema and Lung Function: The Genetic Epidemiology of COPD Study
Creators: Carrie L Pistenmaa - Brigham and Women's Hospital
P Nardelli - Brigham and Women's Hospital
S Y Ash - Brigham and Women's Hospital
C E Come - Brigham and Women's Hospital
A A Diaz - Brigham and Women's Hospital
F N Rahaghi - Brigham and Women's Hospital
R G Barr - Columbia University
K A Young - Colorado School of Public Health
G L Kinney - Colorado School of Public Health
J P Simmons - University of Alabama at Birmingham
R C Wade - University of Alabama at Birmingham
J M Wells - University of Alabama at Birmingham
J E Hokanson - Colorado School of Public Health
G R Washko - Brigham and Women's Hospital
R San José Estépar - Brigham and Women's Hospital
COPDGene Investigators
Contributors: Karin F Hoth (Contributor) - University of Iowa, Psychiatry
Resource Type: Journal article
Publication Details: Chest, Vol.160(2), pp.470-480
DOI: 10.1016/j.chest.2021.01.084
PMID: 33607083
PMCID: PMC8411454
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Grant note: U01 HL089856 / NHLBI NIH HHS R01 HL116931 / NHLBI NIH HHS U01 HL089897 / NHLBI NIH HHS T32 HL105346 / NHLBI NIH HHS R01 HL149877 / NHLBI NIH HHS R01 HL133137 / NHLBI NIH HHS R01 HL149861 / NHLBI NIH HHS R01 HL148215 / NHLBI NIH HHS K23 HL141651 / NHLBI NIH HHS R01 HL116473 / NHLBI NIH HHS
Language: English
Date published: 08/2021
Academic Unit: Psychiatry; Iowa Neuroscience Institute
Record Identifier: 9984293754802771

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