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Synn AJ, Margerie-Mellon CD, Jeong SY, Rahaghi FN, Jhun I, Washko GR, Estépar RSJ, Bankier AA, Mittleman MA, VanderLaan PA, Rice MB. Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography. Pulm Circ 2021; 11:20458940211061284. [PMID: 34881020 PMCID: PMC8647266 DOI: 10.1177/20458940211061284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023] Open
Abstract
Pulmonary hypertension is characterized histologically by intimal and medial
thickening in the small pulmonary arteries, eventually resulting in vascular
“pruning.” Computed tomography (CT)-based quantification of pruning is
associated with clinical measures of pulmonary hypertension, but it is not
established whether CT-based pruning correlates with histologic arterial
remodeling. Our sample consisted of 138 patients who underwent resection for
early-stage lung adenocarcinoma. From histologic sections, we identified small
pulmonary arteries and measured the relative area comprising the intima and
media (VWA%), with higher VWA% representing greater histologic remodeling. From
pre-operative CTs, we used image analysis algorithms to calculate the small
vessel volume fraction (BV5/TBV) as a CT-based indicator of pruning (lower
BV5/TBV represents greater pruning). We investigated relationships of CT pruning
and histologic remodeling using Pearson correlation, simple linear regression,
and multivariable regression with adjustment for age, sex, height, weight,
smoking status, and total pack-years. We also tested for effect modification by
sex and smoking status. In primary models, more severe CT pruning was associated
with greater histologic remodeling. The Pearson correlation coefficient between
BV5/TBV and VWA% was –0.41, and in linear regression models, VWA% was 3.13%
higher (95% CI: 1.95–4.31%, p < 0.0001) per standard deviation lower BV5/TBV.
This association persisted after multivariable adjustment. We found no evidence
that these relationships differed by sex or smoking status. Among individuals
who underwent resection for lung adenocarcinoma, more severe CT-based vascular
pruning was associated with greater histologic arterial remodeling. These
findings suggest CT imaging may be a non-invasive indicator of pulmonary
vascular pathology.
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Affiliation(s)
- Andrew J Synn
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Sun Young Jeong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Farbod N Rahaghi
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Iny Jhun
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - George R Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander A Bankier
- Department of Radiology, University of Massachusetts Medical School, Worchester, MA, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mary B Rice
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Abstract
Pulmonary arterial hypertension is characterized by obliteration and obstruction of the pulmonary arterioles that in turn results in high right ventricular afterload and right heart failure. The pathobiology of pulmonary arterial hypertension is complex, with contributions from multiple pathophysiologic processes that are regulated by a variety of molecular mechanisms. This nature likely explains the limited efficacy of our current therapies, which only target a small portion of the pathobiological mechanisms that underlie advanced disease. Here we review the pathobiology of pulmonary arterial hypertension, focusing on the systemic, cellular, and molecular mechanisms that underlie the disease.
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Affiliation(s)
- Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Room 128A Hanes House, 330 Trent Drive, Durham, NC 27710, USA.
| | - Yen-Rei A Yu
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, 12605 E. 16th Avenue, Aurora, CO 80045, USA
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Abstract
This article reviews the contribution made by nuclear imaging to the assessment, diagnosis and monitoring of patients with respiratory disease. It focuses on several specific areas including the diagnosis of pulmonary embolism, the investigation of intrapulmonary infection and neoplasm and the role of positron emission tomography (PET) scanning.
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Affiliation(s)
- R F Miller
- Department of Medicine, University College of Middlesex School of Medicine, Middlesex Hospital, London, UK
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