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Am J Respir Crit Care Med. 2015 Sep 1;192(5):570-80. doi: 10.1164/rccm.201411-2120OC.

Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study.

Author information

1
1 Department of Radiology and.
2
2 Department of Radiology and Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany.
3
3 Department of Medicine.
4
4 Department of Radiology, and.
5
5 Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland.
6
6 Department of Radiology and.
7
7 Department of Radiology.
8
8 IIHR-Hydroscience & Engineering.
9
9 Department of Biomedical Engineering, Stanford University, Stanford, California.
10
10 Department of Radiology and.
11
11 Department of Medicine, and.
12
12 Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa.
13
13 Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
14
14 Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
15
15 Department of Biomedical Engineering and.
16
16 Department of Biostatistics, Northwestern University, Chicago, Illinois.
17
17 Department of Statistics, Columbia University, New York, New York; and.
18
18 Department of Medicine, University of California at Los Angeles, Los Angeles, California.
19
19 VIDA Diagnostics, Coralville, Iowa.
20
20 Department of Epidemiology, Columbia University Medical Center, New York, New York.

Abstract

RATIONALE:

Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, and brain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease.

OBJECTIVES:

To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema.

METHODS:

PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below -950 Hounsfield units (-950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output.

MEASUREMENTS AND MAIN RESULTS:

Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52% in severe COPD (all P < 0.01 vs. control subjects). PMBF was reduced with greater percentage emphysema-950HU and radiologist-defined emphysema, particularly panlobular and centrilobular emphysema (all P ≤ 0.01). Registration of MRI and CT images revealed that PMBF was reduced in mild COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers.

CONCLUSIONS:

PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature.

KEYWORDS:

chronic obstructive pulmonary disease (COPD); gadolinium-enhanced MRI; lung emphysema; pulmonary microvascular blood flow (PMBF); small airway disease

PMID:
26067761
PMCID:
PMC4595687
DOI:
10.1164/rccm.201411-2120OC
[Indexed for MEDLINE]
Free PMC Article

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