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Chest. 2018 Jan;153(1):65-76. doi: 10.1016/j.chest.2017.09.022. Epub 2017 Sep 21.

Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression.

Collaborators (160)

Crapo J, Silverman E, Make B, Regan E, Beaty T, Laird N, Lange C, Cho MH, Santorico S, Hokanson J, DeMeo D, Hansel N, Hersh C, Castaldi P, McDonald ML, Wan E, Hardin M, Hetmanski J, Parker M, Foreman M, Hobbs B, Busch R, Boueiz A, Castaldi P, Hardin M, Qiao D, Regan E, Halper-Stromberg E, Begum F, Won S, Lutz S, Lynch DA, Coxson HO, Han MK, Hoffman EA, Humphries S, Jacobson FL, Judy PF, Kazerooni EA, Newell JD Jr., Regan E, Ross JC, Estépar RJ, Stoel BC, Tschirren J, Rikxoort EV, van Ginneken B, Washko GR, Wilson CG, Qaisi MA, Gray T, Kluiber A, Mann T, Sieren J, Stinson D, Schroeder J, Beek EV, Jensen R, Everett D, Faino A, Strand M, Wilson C, Hokanson JE, Kinney G, Lutz S, Young K, Pratte K, Duca L, Curtis JL, Martinez CH, Pernicano PG, Hanania N, Alapat P, Bandi V, Atik M, Boriek A, Guntupalli K, Guy E, Parulekar A, Nachiappan A, DeMeo D, Hersh C, Washko GR, Jacobson F, Graham Barr R, Thomashow B, Austin J, D'Souza B, Pearson GDN, Rozenshtein A, MacIntyre N Jr., Washington L, Page McAdams H, McEvoy C, Tashjian J, Wise R, Hansel N, Brown R, Horton K, Putcha N, Casaburi R, Adami A, Porszasz J, Fischer H, Budoff M, Rossiter H, Sharafkhaneh A, Lan C, Wendt C, Bell B, Foreman M, Westney G, Berkowitz E, Bowler R, Lynch D, Rosiello R, Pace D, Criner G, Ciccolella D, Cordova F, Dass C, D'Alonzo G, Desai P, Jacobs M, Kelsen S, Kim V, James Mamary A, Marchetti N, Satti A, Shenoy K, Steiner RM, Swift A, Swift I, Vega-Sanchez ME, Dransfield M, Bailey W, Michael Wells J, Bhatt S, Nath H, Ramsdell J, Friedman P, Soler X, Yen A, Cornellas A, Newell J Jr., Thompson B, Han M, Kazerooni E, Martinez C, Billings J, Allen T, Sciurba F, Chandra D, Weissfeld J, Fuhrman C, Bon J, Anzueto A, Adams S, Maselli-Caceres D, Ruiz ME.

Author information

1
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
2
Department of Electrical and Computer Engineering, Northeastern University, Boston, MA.
3
Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
4
Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
5
Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, CO.
6
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: repjc@channing.harvard.edu.

Abstract

BACKGROUND:

Emphysema has considerable variability in its regional distribution. Craniocaudal emphysema distribution is an important predictor of the response to lung volume reduction. However, there is little consensus regarding how to define upper lobe-predominant and lower lobe-predominant emphysema subtypes. Consequently, the clinical and genetic associations with these subtypes are poorly characterized.

METHODS:

We sought to identify subgroups characterized by upper-lobe or lower-lobe emphysema predominance and comparable amounts of total emphysema by analyzing data from 9,210 smokers without alpha-1-antitrypsin deficiency in the Genetic Epidemiology of COPD (COPDGene) cohort. CT densitometric emphysema was measured in each lung lobe. Random forest clustering was applied to lobar emphysema variables after regressing out the effects of total emphysema. Clusters were tested for association with clinical and imaging outcomes at baseline and at 5-year follow-up. Their associations with genetic variants were also compared.

RESULTS:

Three clusters were identified: minimal emphysema (n = 1,312), upper lobe-predominant emphysema (n = 905), and lower lobe-predominant emphysema (n = 796). Despite a similar amount of total emphysema, the lower-lobe group had more severe airflow obstruction at baseline and higher rates of metabolic syndrome compared with subjects with upper-lobe predominance. The group with upper-lobe predominance had greater 5-year progression of emphysema, gas trapping, and dyspnea. Differential associations with known COPD genetic risk variants were noted.

CONCLUSIONS:

Subgroups of smokers defined by upper-lobe or lower-lobe emphysema predominance exhibit different functional and radiological disease progression rates, and the upper-lobe predominant subtype shows evidence of association with known COPD genetic risk variants. These subgroups may be useful in the development of personalized treatments for COPD.

KEYWORDS:

COPD; COPD disease progression; clustering; emphysema distribution; machine learning

PMID:
28943279
PMCID:
PMC6026264
[Available on 2019-01-01]
DOI:
10.1016/j.chest.2017.09.022

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