Pulmonary arterial enlargement and acute exacerbations of COPD
J Michael Wells, George R Washko, MeiLan K Han, Naseer Abbas, Hrudaya Nath, A James Mamary, Elizabeth Regan, William C Bailey, Fernando J Martinez, Elizabeth Westfall, Terri H Beaty, Douglas Curran-Everett, Jeffrey L Curtis, John E Hokanson, David A Lynch, Barry J Make, James D Crapo, Edwin K Silverman, Russell P Bowler, Mark T Dransfield, COPDGene Investigators, ECLIPSE Study Investigators, Jeffrey Curtis, Ella Kazerooni, Nicola Hanania, Philip Alapat, Venkata Bandi, Kalpalatha Guntupalli, Elizabeth Guy, Antara Mallampalli, Charles Trinh, Mustafa Atik, Dawn DeMeo, Craig Hersh, George Washko, Francine Jacobson, R Graham Barr, Byron Thomashow, John Austin, Neil MacIntyre Jr, Lacey Washington, H Page McAdams, Richard Rosiello, Timothy Bresnahan, Charlene McEvoy, Joseph Tashjian, Robert Wise, Nadia Hansel, Robert Brown, Gregory Diette, Richard Casaburi, Janos Porszasz, Hans Fischer, Matt Budoff, Amir Sharafkhaneh, Charles Trinh, Hirani Kamal, Roham Darvishi, Dennis Niewoehner, Tadashi Allen, Quentin Anderson, Kathryn Rice, Marilyn Foreman, Gloria Westney, Eugene Berkowitz, Russell Bowler, David Lynch, Joyce Schroeder, Gerard Criner, Victor Kim, Nathaniel Marchetti, Aditi Satti, A James Mamary, Robert Steiner, Chandra Dass, Mark Dransfield, William Bailey, Hrudaya Nath, Joe Ramsdell, Paul Friedman, Geoffrey McLennan, Edwin J R van Beek, Brad Thompson, Dwight Look, John Newell Jr, Fernando Martinez, MeiLan Han, Ella Kazerooni, Christine Wendt, Tadashi Allen, Frank Sciurba, Joel Weissfeld, Carl Fuhrman, Jessica Bon, Antonio Anzueto, Sandra Adams, Carlos Orozco, Mario Ruiz, James Crapo, Edwin Silverman, Barry Make, Elizabeth Regan, Sarah Moyle, Douglas Stinson, Terri Beaty, Barbara Klanderman, Nan Laird, Christoph Lange, Michael Cho, Stephanie Santorico, John Hokanson, Dawn DeMeo, Nadia Hansel, Craig Hersh, Jacqueline Hetmanski, Tanda Murray, David Lynch, Joyce Schroeder, John Newell Jr, John Reilly, Harvey Coxson, Philip Judy, Eric Hoffman, George Washko, Raul San Jose Estepar, James Ross, Rebecca Leek, Jordan Zach, Alex Kluiber, Jered Sieren, Heather Baumhauer, Verity McArthur, Dzimitry Kazlouski, Andrew Allen, Tanya Mann, Anastasia Rodionova, Robert Jensen, Homayoon Farzadegan, Stacey Meyerer, Shivam Chandan, Samantha Bragan, James Murphy, Douglas Everett, Carla Wilson, Ruthie Knowles, Amber Powell, Joe Piccoli, Maura Robinson, Margaret Forbes, Martina Wamboldt, John Hokanson, Marci Sontag, Jennifer Black-Shinn, Gregory Kinney, Per Bakke, Courtney Crim, Harvey Coxson, Lisa Edwards, David Lomas, William MacNee, Edwin Silverman, Ruth Tal-Singer, Jørgen Vestbo, Julie Yates, Alvar Agusti, Peter Calverley, Bartolome Celli, Courtney Crim, Bruce Miller, William MacNee, Stephen Rennard, Ruth Tal-Singer, Emiel Wouters, Julie Yates, Yavor Ivanov, Kosta Kostov, Jean Bourbeau, Mark Fitzgerald, Paul Hernandez, Kieran Killian, Robert Levy, Francois Maltais, Denis O'Donnell, Jan Krepelka, Jørgen Vestbo, Emiel Wouters, Dean Quinn, Per Bakke, Mitja Kosnik, Alvar Agusti, Jaume Sauleda, Yuri Feschenko, Vladamir Gavrisyuk, Lyudmila Yashina, Nadezhda Monogarova, Peter Calverley, David Lomas, William MacNee, Dave Singh, Jadwiga Wedzicha, Antonio Anzueto, Sidney Braman, Richard Casaburi, Bart Celli, Glenn Giessel, Mark Gotfried, Gary Greenwald, Nicola Hanania, Don Mahler, Barry Make, Stephen Rennard, Carolyn Rochester, Paul Scanlon, Dan Schuller, Frank Sciurba, Amir Sharafkhaneh, Thomas Siler, Edwin Silverman, Adam Wanner, Robert Wise, Richard ZuWallack, J Michael Wells, George R Washko, MeiLan K Han, Naseer Abbas, Hrudaya Nath, A James Mamary, Elizabeth Regan, William C Bailey, Fernando J Martinez, Elizabeth Westfall, Terri H Beaty, Douglas Curran-Everett, Jeffrey L Curtis, John E Hokanson, David A Lynch, Barry J Make, James D Crapo, Edwin K Silverman, Russell P Bowler, Mark T Dransfield, COPDGene Investigators, ECLIPSE Study Investigators, Jeffrey Curtis, Ella Kazerooni, Nicola Hanania, Philip Alapat, Venkata Bandi, Kalpalatha Guntupalli, Elizabeth Guy, Antara Mallampalli, Charles Trinh, Mustafa Atik, Dawn DeMeo, Craig Hersh, George Washko, Francine Jacobson, R Graham Barr, Byron Thomashow, John Austin, Neil MacIntyre Jr, Lacey Washington, H Page McAdams, Richard Rosiello, Timothy Bresnahan, Charlene McEvoy, Joseph Tashjian, Robert Wise, Nadia Hansel, Robert Brown, Gregory Diette, Richard Casaburi, Janos Porszasz, Hans Fischer, Matt Budoff, Amir Sharafkhaneh, Charles Trinh, Hirani Kamal, Roham Darvishi, Dennis Niewoehner, Tadashi Allen, Quentin Anderson, Kathryn Rice, Marilyn Foreman, Gloria Westney, Eugene Berkowitz, Russell Bowler, David Lynch, Joyce Schroeder, Gerard Criner, Victor Kim, Nathaniel Marchetti, Aditi Satti, A James Mamary, Robert Steiner, Chandra Dass, Mark Dransfield, William Bailey, Hrudaya Nath, Joe Ramsdell, Paul Friedman, Geoffrey McLennan, Edwin J R van Beek, Brad Thompson, Dwight Look, John Newell Jr, Fernando Martinez, MeiLan Han, Ella Kazerooni, Christine Wendt, Tadashi Allen, Frank Sciurba, Joel Weissfeld, Carl Fuhrman, Jessica Bon, Antonio Anzueto, Sandra Adams, Carlos Orozco, Mario Ruiz, James Crapo, Edwin Silverman, Barry Make, Elizabeth Regan, Sarah Moyle, Douglas Stinson, Terri Beaty, Barbara Klanderman, Nan Laird, Christoph Lange, Michael Cho, Stephanie Santorico, John Hokanson, Dawn DeMeo, Nadia Hansel, Craig Hersh, Jacqueline Hetmanski, Tanda Murray, David Lynch, Joyce Schroeder, John Newell Jr, John Reilly, Harvey Coxson, Philip Judy, Eric Hoffman, George Washko, Raul San Jose Estepar, James Ross, Rebecca Leek, Jordan Zach, Alex Kluiber, Jered Sieren, Heather Baumhauer, Verity McArthur, Dzimitry Kazlouski, Andrew Allen, Tanya Mann, Anastasia Rodionova, Robert Jensen, Homayoon Farzadegan, Stacey Meyerer, Shivam Chandan, Samantha Bragan, James Murphy, Douglas Everett, Carla Wilson, Ruthie Knowles, Amber Powell, Joe Piccoli, Maura Robinson, Margaret Forbes, Martina Wamboldt, John Hokanson, Marci Sontag, Jennifer Black-Shinn, Gregory Kinney, Per Bakke, Courtney Crim, Harvey Coxson, Lisa Edwards, David Lomas, William MacNee, Edwin Silverman, Ruth Tal-Singer, Jørgen Vestbo, Julie Yates, Alvar Agusti, Peter Calverley, Bartolome Celli, Courtney Crim, Bruce Miller, William MacNee, Stephen Rennard, Ruth Tal-Singer, Emiel Wouters, Julie Yates, Yavor Ivanov, Kosta Kostov, Jean Bourbeau, Mark Fitzgerald, Paul Hernandez, Kieran Killian, Robert Levy, Francois Maltais, Denis O'Donnell, Jan Krepelka, Jørgen Vestbo, Emiel Wouters, Dean Quinn, Per Bakke, Mitja Kosnik, Alvar Agusti, Jaume Sauleda, Yuri Feschenko, Vladamir Gavrisyuk, Lyudmila Yashina, Nadezhda Monogarova, Peter Calverley, David Lomas, William MacNee, Dave Singh, Jadwiga Wedzicha, Antonio Anzueto, Sidney Braman, Richard Casaburi, Bart Celli, Glenn Giessel, Mark Gotfried, Gary Greenwald, Nicola Hanania, Don Mahler, Barry Make, Stephen Rennard, Carolyn Rochester, Paul Scanlon, Dan Schuller, Frank Sciurba, Amir Sharafkhaneh, Thomas Siler, Edwin Silverman, Adam Wanner, Robert Wise, Richard ZuWallack
Abstract
Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exacerbations, though pulmonary vascular abnormalities also occur early in the course of the disease. We hypothesized that a computed tomographic (CT) metric of pulmonary vascular disease (pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the diameter of the aorta [PA:A ratio] of >1) would be associated with severe COPD exacerbations.
Methods: We conducted a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between a PA:A ratio of more than 1 and a history at enrollment of severe exacerbations requiring hospitalization and then examined the usefulness of the ratio as a predictor of these events in a longitudinal follow-up of this cohort, as well as in an external validation cohort. We used logistic-regression and zero-inflated negative binomial regression analyses and adjusted for known risk factors for exacerbation.
Results: Multivariate logistic-regression analysis showed a significant association between a PA:A ratio of more than 1 and a history of severe exacerbations at the time of enrollment in the trial (odds ratio, 4.78; 95% confidence interval [CI], 3.43 to 6.65; P<0.001). A PA:A ratio of more than 1 was also independently associated with an increased risk of future severe exacerbations in both the trial cohort (odds ratio, 3.44; 95% CI, 2.78 to 4.25; P<0.001) and the external validation cohort (odds ratio, 2.80; 95% CI, 2.11 to 3.71; P<0.001). In both cohorts, among all the variables analyzed, a PA:A ratio of more than 1 had the strongest association with severe exacerbations.
Conclusions: Pulmonary artery enlargement (a PA:A ratio of >1), as detected by CT, was associated with severe exacerbations of COPD. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov numbers, NCT00608764 and NCT00292552.).
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Source: PubMed