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Pulmonary arterial enlargement and acute exacerbations of COPD

James Wells, George Washko, MeiLan Han, Naseer Abbas, Hrudaya Nath, Albert Mamary, Elizabeth Regan, William Bailey, Fernando Martinez, Elizabeth Westfall, Russell Bowler, Mark Dransfield
European Respiratory Journal 2012 40: P2728; DOI:
James Wells
1Lung Health Center, Division of Pulmonary and Critical Care, University of Alabama at Birmingham (UAB), AL, United States
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George Washko
2Pulmonary Division, Brigham & Women's Hospital, Boston, MA, United States
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MeiLan Han
3Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, United States
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Naseer Abbas
1Lung Health Center, Division of Pulmonary and Critical Care, University of Alabama at Birmingham (UAB), AL, United States
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Hrudaya Nath
4Department of Radiology, University of Alabama at Birmingham (UAB), AL, United States
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Albert Mamary
5Section of Pulmonary and Critical Care, Temple University, Philadelphia, PA, United States
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Elizabeth Regan
6Pulmonary Division, National Jewish Hospital, Denver, CO, United States
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William Bailey
1Lung Health Center, Division of Pulmonary and Critical Care, University of Alabama at Birmingham (UAB), AL, United States
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Fernando Martinez
3Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, United States
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Elizabeth Westfall
1Lung Health Center, Division of Pulmonary and Critical Care, University of Alabama at Birmingham (UAB), AL, United States
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Russell Bowler
6Pulmonary Division, National Jewish Hospital, Denver, CO, United States
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Mark Dransfield
1Lung Health Center, Division of Pulmonary and Critical Care, University of Alabama at Birmingham (UAB), AL, United States
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Abstract

Background: Exacerbations of COPD (AECOPD) are associated with accelerated loss of lung function and mortality. 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 AECOPD though pulmonary vascular abnormalities also occur early in the disease. We hypothesized that a computed tomography (CT) metric of pulmonary vascular disease (pulmonary artery (PA) enlargement as determined by a PA/Aorta (A) ratio > 1) would predict severe AECOPD.

Methods: The COPDGene study is a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between PA/A>1 and severe AECOPD requiring hospitalization as reported at enrolment and then examined its utility as a predictor of these events in longitudinal follow-up as well as in an external validation cohort [Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE)] using logistic and zero-inflated negative binomial regression and adjusting for known risk factors for AECOPD.

Results: Multivariate logistic regression demonstrated a significant association between PA/A>1 and severe AECOPD [OR 3.60 (95% CI, 2.49-5.22, p<0.001)] at enrolment in COPDGene. PA/A>1 also independently predicted the occurrence [OR 2.03 (95% CI, 1.17-3.49, p=0.01) in COPDGene and OR 2.80 (95% CI, 2.11-3.71, p<0.001) in ECLIPSE] and frequency of future severe AECOPD in both cohorts. In ECLIPSE, PA/A>1 was the strongest predictor of severe AECOPD over both 1 and 3 years of follow-up.

Conclusions: CT detected pulmonary artery enlargement (PA/A>1) predicts severe COPD exacerbations.

  • COPD - exacerbations
  • Imaging
  • Comorbidities
  • © 2012 ERS
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Pulmonary arterial enlargement and acute exacerbations of COPD
James Wells, George Washko, MeiLan Han, Naseer Abbas, Hrudaya Nath, Albert Mamary, Elizabeth Regan, William Bailey, Fernando Martinez, Elizabeth Westfall, Russell Bowler, Mark Dransfield
European Respiratory Journal Sep 2012, 40 (Suppl 56) P2728;

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Pulmonary arterial enlargement and acute exacerbations of COPD
James Wells, George Washko, MeiLan Han, Naseer Abbas, Hrudaya Nath, Albert Mamary, Elizabeth Regan, William Bailey, Fernando Martinez, Elizabeth Westfall, Russell Bowler, Mark Dransfield
European Respiratory Journal Sep 2012, 40 (Suppl 56) P2728;
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