Format

Send to

Choose Destination
See comment in PubMed Commons below
N Engl J Med. 2012 Sep 6;367(10):913-21. doi: 10.1056/NEJMoa1203830. Epub 2012 Sep 3.

Pulmonary arterial enlargement and acute exacerbations of COPD.

Collaborators (199)

Curtis J, Kazerooni E, Hanania N, Alapat P, Bandi V, Guntupalli K, Guy E, Mallampalli A, Trinh C, Atik M, DeMeo D, Hersh C, Washko G, Jacobson F, Barr RG, Thomashow B, Austin J, MacIntyre N Jr, Washington L, McAdams HP, Rosiello R, Bresnahan T, McEvoy C, Tashjian J, Wise R, Hansel N, Brown R, Diette G, Casaburi R, Porszasz J, Fischer H, Budoff M, Sharafkhaneh A, Trinh C, Kamal H, Darvishi R, Niewoehner D, Allen T, Anderson Q, Rice K, Foreman M, Westney G, Berkowitz E, Bowler R, Lynch D, Schroeder J, Criner G, Kim V, Marchetti N, Satti A, Mamary A, Steiner R, Dass C, Dransfield M, Bailey W, Nath H, Ramsdell J, Friedman P, McLennan G, van Beek EJ, Thompson B, Look D, Newell J Jr, Martinez F, Han M, Kazerooni E, Wendt C, Allen T, Sciurba F, Weissfeld J, Fuhrman C, Bon J, Anzueto A, Adams S, Orozco C, Ruiz M, Crapo J, Silverman E, Make B, Regan E, Moyle S, Stinson D, Beaty T, Klanderman B, Laird N, Lange C, Cho M, Santorico S, Hokanson J, DeMeo D, Hansel N, Hersh C, Hetmanski J, Murray T, Lynch D, Schroeder J, Newell J Jr, Reilly J, Coxson H, Judy P, Hoffman E, Washko G, Estepar RS, Ross J, Leek R, Zach J, Kluiber A, Sieren J, Baumhauer H, McArthur V, Kazlouski D, Allen A, Mann T, Rodionova A, Jensen R, Farzadegan H, Meyerer S, Chandan S, Bragan S, Murphy J, Everett D, Wilson C, Knowles R, Powell A, Piccoli J, Robinson M, Forbes M, Wamboldt M, Hokanson J, Sontag M, Black-Shinn J, Kinney G, Bakke P, Crim C, Coxson H, Edwards L, Lomas D, MacNee W, Silverman E, Tal-Singer R, Vestbo J, Yates J, Agusti A, Calverley P, Celli B, Crim C, Miller B, MacNee W, Rennard S, Tal-Singer R, Wouters E, Yates J, Ivanov Y, Kostov K, Bourbeau J, Fitzgerald M, Hernandez P, Killian K, Levy R, Maltais F, O'Donnell D, Krepelka J, Vestbo J, Wouters E, Quinn D, Bakke P, Kosnik M, Agusti A, Sauleda J, Feschenko Y, Gavrisyuk V, Yashina L, Monogarova N, Calverley P, Lomas D, MacNee W, Singh D, Wedzicha J, Anzueto A, Braman S, Casaburi R, Celli B, Giessel G, Gotfried M, Greenwald G, Hanania N, Mahler D, Make B, Rennard S, Rochester C, Scanlon P, Schuller D, Sciurba F, Sharafkhaneh A, Siler T, Silverman E, Wanner A, Wise R, ZuWallack R.

Author information

1
Lung Health Center, Division of Pulmonary Allergy and Critical Care, University of Alabama at Birmingham, 422 THT 1900 University Blvd., Birmingham, AL 35294, USA. jmwells@uab.edu

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.).

PMID:
22938715
PMCID:
PMC3690810
DOI:
10.1056/NEJMoa1203830
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Atypon Icon for PubMed Central
    Loading ...
    Support Center