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

• Published in: Chest Vol. 160; no. 2; pp. 470 - 480
• Main Authors: Pistenmaa, Carrie L, Nardelli, P, Ash, S Y, Come, C E, Diaz, A A, Rahaghi, F N, Barr, R G, Young, K A, Kinney, G L, Simmons, J P, Wade, R C, Wells, J M, Hokanson, J E, Washko, G R, San José Estépar, R
• Format: Journal Article
• Language: English
• Published: United States American College of Chest Physicians 01-08-2021
• Subjects: COPD: Original Research; 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; lung function; longitudinal; pulmonary circulation; imaging; emphysema
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2021.01.084

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.