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Harder EM, Abtin F, Nardelli P, Brownstein A, Channick RN, Washko GR, Goldin J, San José Estépar R, Rahaghi FN, Saggar R. Pulmonary Hypertension in Idiopathic Interstitial Pneumonia Is Associated with Small Vessel Pruning. Am J Respir Crit Care Med 2024; 209:1170-1173. [PMID: 38502314 DOI: 10.1164/rccm.202312-2343le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Eileen M Harder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | | | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Adam Brownstein
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
| | - Richard N Channick
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | | | | | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Rajan Saggar
- Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
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2
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Harder EM, Divo MJ, Washko GR, Leopold JA, Rahaghi FN, Waxman AB. Implications of Mean Pulmonary Arterial Wedge Pressure Trajectories in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2024; 209:316-324. [PMID: 37939220 PMCID: PMC10840771 DOI: 10.1164/rccm.202306-1072oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
Rationale: The mean pulmonary arterial wedge pressure (mPAWP) is the critical hemodynamic factor differentiating group 1 pulmonary arterial hypertension (PAH) from group 2 pulmonary hypertension associated with left heart disease. Despite the discrepancy between the mPAWP upper physiologic normal and current PAH definitions, the implications of the initial mPAWP for PAH clinical trajectory are poorly understood. Objectives: To model longitudinal mPAWP trajectories in PAH over 10 years and examine the clinical and hemodynamic factors associated with trajectory membership. Methods: Adult patients with PAH with two or more right heart catheterizations were identified from a multiinstitution healthcare system in eastern Massachusetts. mPAWP trajectories were constructed via group-based trajectory modeling. Feature selection was performed in least absolute shrinkage and selection operator regression. Logistic regression was used to assess associations between trajectory membership, baseline characteristics, and transplant-free survival. Measurements and Main Results: Among 301 patients with PAH, there were two distinct mPAWP trajectories, termed "mPAWP-high" (n = 71; 23.6%) and "mPAWP-low" (n = 230; 76.4%), based on the ultimate mPAWP value. Initial mPAWP clustered around median 12 mm Hg (interquartile range [IQR], 8-14 mm Hg) in the mPAWP-high and 9 mm Hg (IQR, 6-11 mm Hg) in the mPAWP-low trajectories (P < 0.001). After feature selection, initial mPAWP ⩾12 mm Hg predicted an mPAWP-high trajectory (odds ratio, 3.2; 95% confidence interval, 1.4-6.1; P = 0.0006). An mPAWP-high trajectory was associated with shorter transplant-free survival (vs. mPAWP-low, median, 7.8 vs. 11.3 yr; log-rank P = 0.017; age-adjusted P = 0.217). Conclusions: Over 10 years, the mPAWP followed two distinct trajectories, with 25% evolving into group 2 pulmonary hypertension physiology. Using routine baseline data, longitudinal mPAWP trajectory could be predicted accurately, with initial mPAWP ⩾12 mm Hg as one of the strongest predictors.
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Affiliation(s)
| | | | | | - Jane A. Leopold
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Synn AJ, Harder EM, Nardelli P, Ross JC, Maron BA, Leopold JA, Waxman AB, San José Estépar R, Washko GR, Rahaghi FN. Automated CT-Based Quantification of Pulmonary Veins Shows Greater Central Venous Dilation in Group 2 Pulmonary Hypertension Compared With Group 1 Pulmonary Arterial Hypertension and Control Subjects. CHEST Pulm 2023; 1:100020. [PMID: 38144213 PMCID: PMC10745213 DOI: 10.1016/j.chpulm.2023.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Affiliation(s)
- Andrew J Synn
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - Eileen M Harder
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - Pietro Nardelli
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - James C Ross
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - Bradley A Maron
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - Jane A Leopold
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - Raúl San José Estépar
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - George R Washko
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care (A. J. S.), Beth Israel Deaconess Medical Center, the Division of Pulmonary and Critical Care (E. M. H., A. B. W., G. R. W., and F. N. R.), Department of Radiology (P. N., J. C. R., and R. S. J. E.), and the Division of Cardiovascular Medicine (J. A. L.), Brigham and Women's Hospital, Harvard Medical School; and the Department of Medicine (B. A. M.), University of Maryland School of Medicine, and the University of Maryland-Institute for Health Computing (B. A. M.), Bethesda, MD
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Synn AJ, Litchman TD, De Margerie-Mellon C, Bankier AA, Rahaghi FN, Washko GR, San José Estépar R, VanderLaan PA, Rice MB. Relative Loss of Small Pulmonary Vessels on Imaging and Risk of Recurrence of Resected Lung Adenocarcinoma. Ann Am Thorac Soc 2023; 20:1673-1676. [PMID: 37590317 PMCID: PMC10632925 DOI: 10.1513/annalsats.202303-191rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/17/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Andrew J. Synn
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | | | | | | | | | | | | | - Mary B. Rice
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
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Graham BB, Hilton JF, Lee MH, Kumar R, Balladares DF, Rahaghi FN, Estépar RSJ, Mickael C, Lima RLB, Loureiro CM, Lucena J, Oliveira RK, Corrêa RDA. Is pulmonary arterial hypertension associated with schistosomiasis distinct from pulmonary arterial hypertension associated with portal hypertension? JHLT Open 2023; 1:100007. [PMID: 38050478 PMCID: PMC10695267 DOI: 10.1016/j.jhlto.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Pulmonary arterial hypertension associated with schistosomiasis (SchPAH) and pulmonary arterial hypertension associated with portal hypertension (PoPAH) are lung diseases that develop in the presence of liver diseases. However, mechanistic pathways by which the underlying liver conditions and other drivers contribute to the development and progression of pulmonary arterial hypertension (PAH) are unclear for both etiologies. In turn, these unknowns limit certainty of strategies to prevent, diagnose, and reverse the resultant PAH. Here we consider specific mechanisms that contribute to SchPAH and PoPAH, identifying those that may be shared and those that appear to be unique to each etiology, in the hope that this exploration will both highlight known causal drivers and identify knowledge gaps appropriate for future research. Overall, the key pathophysiologic differences that we identify between SchPAH and PoPAH suggest that they are not variants of a single condition.
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Affiliation(s)
- Brian B. Graham
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Michael H. Lee
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Rahul Kumar
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Dara Fonseca Balladares
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Farbod N. Rahaghi
- Pulmonary Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Claudia Mickael
- Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Juliana Lucena
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Rudolf K.F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo de Amorim Corrêa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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6
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Hassan SM, Nardelli P, Minhas JK, Ash SY, Estépar RSJ, Antkowiak MC, Badlam JB, Piazza G, Estépar RSJ, Washko GR, Rahaghi FN. CT imaging determinants of persistent hypoxemia in acute intermediate-risk pulmonary embolism. J Thromb Thrombolysis 2023:10.1007/s11239-023-02813-x. [PMID: 37140805 DOI: 10.1007/s11239-023-02813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/05/2023]
Abstract
The factors associated with persistent hypoxemia after pulmonary embolus (PE) are not well understood. Predicting the need for oxygen post discharge at the time of diagnosis using available CT imaging will enable better discharge planning. To examine the relationship between CT derived imaging markers (automated computation of arterial small vessel fraction, pulmonary artery diameter to aortic diameter ratio (PA:A), right to left ventricular diameter ratio (RV:LV) and new oxygen requirement at the time of discharge in patients diagnosed with acute intermediate-risk PE. CT measurements were obtained in a retrospective cohort of patients with acute-intermediate risk PE admitted to Brigham and Women's Hospital between 2009 and 2017. Twenty one patients without a history of lung disease requiring home oxygen and 682 patients without discharge oxygen requirements were identified. There was an increased median PA:A ratio (0.98 vs. 0.92, p = 0.02) and arterial small vessel fraction (0.32 vs. 0.39, p = 0.001) in the oxygen-requiring group], but no difference in the median RV:LV ratio (1.20 vs. 1.20, p = 0.74). Being in the upper quantile for the arterial small vessel fraction was associated with decreased odds of oxygen requirement (OR 0.30 [0.10-0.78], p = 0.02). Loss of arterial small vessel volume as measured by arterial small vessel fraction and an increase in the PA:A ratio at the time of diagnosis were associated with the presence of persistent hypoxemia on discharge in acute intermediate-risk PE.
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Affiliation(s)
- Syed Moin Hassan
- Division of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, VT, USA.
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasleen K Minhas
- Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rubén San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - MaryEllen C Antkowiak
- Division of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, VT, USA
| | - Jessica B Badlam
- Division of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, VT, USA
| | - Gregory Piazza
- Division of Cardiovascular Medicine, 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
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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7
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Choi B, Adan N, Doyle TJ, San José Estépar R, Harmouche R, Humphries SM, Moll M, Cho MH, Putman RK, Hunninghake GM, Kalhan R, Liu GY, Diaz AA, Mason SE, Rahaghi FN, Pistenmaa CL, Enzer N, Poynton C, Sánchez-Ferrero GV, Ross JC, Lynch DA, Martinez FJ, Han MK, Bowler RP, Wilson DO, Rosas IO, Washko GR, San José Estépar R, Ash SY. Quantitative Interstitial Abnormality Progression and Outcomes in the Genetic Epidemiology of COPD and Pittsburgh Lung Screening Study Cohorts. Chest 2023; 163:164-175. [PMID: 35780812 PMCID: PMC9859724 DOI: 10.1016/j.chest.2022.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The risk factors and clinical outcomes of quantitative interstitial abnormality progression over time have not been characterized. RESEARCH QUESTIONS What are the associations of quantitative interstitial abnormality progression with lung function, exercise capacity, and mortality? What are the demographic and genetic risk factors for quantitative interstitial abnormality progression? STUDY DESIGN AND METHODS Quantitative interstitial abnormality progression between visits 1 and 2 was assessed from 4,635 participants in the Genetic Epidemiology of COPD (COPDGene) cohort and 1,307 participants in the Pittsburgh Lung Screening Study (PLuSS) cohort. We used multivariable linear regression to determine the risk factors for progression and the longitudinal associations between progression and FVC and 6-min walk distance, and Cox regression models for the association with mortality. RESULTS Age at enrollment, female sex, current smoking status, and the MUC5B minor allele were associated with quantitative interstitial abnormality progression. Each percent annual increase in quantitative interstitial abnormalities was associated with annual declines in FVC (COPDGene: 8.5 mL/y; 95% CI, 4.7-12.4 mL/y; P < .001; PLuSS: 9.5 mL/y; 95% CI, 3.7-15.4 mL/y; P = .001) and 6-min walk distance, and increased mortality (COPDGene: hazard ratio, 1.69; 95% CI, 1.34-2.12; P < .001; PLuSS: hazard ratio, 1.28; 95% CI, 1.10-1.49; P = .001). INTERPRETATION The objective, longitudinal measurement of quantitative interstitial abnormalities may help identify people at greatest risk for adverse events and most likely to benefit from early intervention.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | - Najma Adan
- Department of Biology, University of Washington, Bothell, WA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Rola Harmouche
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gabrielle Y Liu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Stefanie E Mason
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Nicholas Enzer
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Clare Poynton
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Gonzalo Vegas Sánchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Russell P Bowler
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ivan O Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
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8
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Dolliver WR, Wang W, Nardelli P, Rahaghi FN, Orejas JL, Maselli DJ, Yen A, Young K, Kinney G, Estépar RSJ, Diaz AA. Pulmonary arterial pruning is associated with CT-derived bronchiectasis progression in smokers. Respir Med 2022; 202:106971. [PMID: 36116143 DOI: 10.1016/j.rmed.2022.106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
Loss of small pulmonary arteries measured as the ratio of blood vessel volume in arteries <5 mm2 in cross-section to total arterial blood vessel volume (BV5a/TBVa), with lower values indicating more pruning, was associated with 5-yr progressing CT-derived bronchiectasis in smokers (Odds Ratio (OR) [95% Confidence interval], 1.28 [1.07-1.53] per 5% lower BV5a/TBVa, P = 0.007). Corresponding results in smokers with COPD were: OR 1.45 [1.11-1.89] per 5% lower BV5a/TBVa, P = 0.007. The results support a vascular factor for structural progression of bronchiectasis.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Wei Wang
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital, Boston, USA
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Jose L Orejas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, University of Texas, San Antonio, USA
| | - Andrew Yen
- Department of Radiology, University of California, San Diego, USA
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, USA
| | - Gregory Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, USA
| | | | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA.
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9
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McNeill J, Chernofsky A, Nayor M, Rahaghi FN, San Jose Estepar R, Washko G, Synn A, Vasan RS, O'Connor G, Larson MG, Ho JE, Lewis GD. The association of lung function and pulmonary vasculature volume with cardiorespiratory fitness in the community. Eur Respir J 2022; 60:13993003.01821-2021. [PMID: 34996832 PMCID: PMC9259762 DOI: 10.1183/13993003.01821-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/06/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cardiorespiratory fitness is not limited by pulmonary mechanical reasons in the majority of adults. However, the degree to which lung function contributes to exercise response patterns among ostensibly healthy individuals remains unclear. METHODS We examined 2314 Framingham Heart Study participants who underwent cardiopulmonary exercise testing (CPET) and pulmonary function testing. We investigated the association of FEV1, FVC, FEV1/FVC and DLCO with the primary outcome of peak VO2, along with other CPET parameters using multivariable linear regression. Finally, we investigated the association of total and peripheral pulmonary blood vessel volume with peak VO2. RESULTS We found lower FEV1, FVC and DLCO were associated with lower peak VO2. For example, a one-liter lower FEV1 and FVC were associated with 7.1% (95% CI: 5.1%, 9.1%) and 6.0% (95% CI: 4.3%, 7.7%) lower peak VO2, respectively. By contrast, FEV1/FVC ratio was not associated with peak VO2. Lower lung function was associated with lower oxygen uptake efficiency slope oxygen pulse slope, VO2 at AT, VE at AT and breathing reserve. In addition, lower total and peripheral pulmonary blood vessel volume were associated with a lower peak VO2. CONCLUSION In a large, community-based cohort of adults, we found lower FEV1, FVC and DLCO were associated with lower exercise capacity, as well as oxygen uptake efficiency slope and ventilatory efficiency. In addition, lower total and peripheral pulmonary blood vessel volume were associated with lower peak VO2. These findings underscore the importance of lung function and blood vessel volume as contributors to overall exercise capacity.
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Affiliation(s)
- Jenna McNeill
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Co-authors
| | - Ariel Chernofsky
- Boston University and National Heart, Lung and Blood Institute Framingham Heart Study, Framingham, MA, USA.,Biostatistics Department, Boston University School of Public Health, Boston, MA, USA.,Co-authors
| | - Matthew Nayor
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raul San Jose Estepar
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew Synn
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Framingham Heart Study and Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Boston University School of Medicine, Department of Epidemiology Boston University School of Public Health, Boston, Massachusetts
| | - George O'Connor
- Framingham Heart Study and Sections of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Boston University School of Medicine, Department of Epidemiology Boston University School of Public Health, Boston, Massachusetts
| | - Martin G Larson
- Boston University and National Heart, Lung and Blood Institute Framingham Heart Study, Framingham, MA, USA.,Biostatistics Department, Boston University School of Public Health, Boston, MA, USA
| | - Jennifer E Ho
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts .,Co-authors
| | - Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Co-authors
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10
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Rahaghi FN, Trieu M, Shaikh F, Abtin F, Diaz AA, Liang LL, Barjaktarevic I, Channick RN, San José Estépar R, Washko GR, Saggar R. Evolution of Obstructive Lung Function in Advanced Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2021; 204:1478-1481. [PMID: 34555310 PMCID: PMC8865712 DOI: 10.1164/rccm.202105-1169le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Farbod N. Rahaghi
- Brigham and Women's Hospital and Harvard Medical SchoolBoston, Massachusetts
| | - Megan Trieu
- University of California, Los AngelesLos Angeles, California
| | - Faisal Shaikh
- University of California, Los AngelesLos Angeles, California
| | - Fereidoun Abtin
- University of California, Los AngelesLos Angeles, California
| | - Alejandro A. Diaz
- Brigham and Women's Hospital and Harvard Medical SchoolBoston, Massachusetts
| | - Lloyd L. Liang
- University of California, Los AngelesLos Angeles, California
| | | | | | | | - George R. Washko
- Brigham and Women's Hospital and Harvard Medical SchoolBoston, Massachusetts
| | - Rajan Saggar
- University of California, Los AngelesLos Angeles, California
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Abstract
There is a growing body of evidence that hypercoagulability is present in stable COPD, involves changes in multiple coagulation factors, and is not simply associated with major causes of inflammation and thrombosis https://bit.ly/3F5NnfN.
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Affiliation(s)
- Farbod N. Rahaghi
- Pulmonary and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie L. Pistenmaa
- Pulmonary and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Minhas J, Nardelli P, Hassan SM, Al-Naamani N, Harder E, Ash S, Sánchez-Ferrero GV, Mason S, Hunsaker AR, Piazza G, Goldhaber SZ, Waxman AB, Kawut SM, Estépar RSJ, Washko GR, Rahaghi FN. Loss of Pulmonary Vascular Volume as a Predictor of Right Ventricular Dysfunction and Mortality in Acute Pulmonary Embolism. Circ Cardiovasc Imaging 2021; 14:e012347. [PMID: 34544259 DOI: 10.1161/circimaging.120.012347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In acute pulmonary embolism, chest computed tomography angiography derived metrics, such as the right ventricle (RV): left ventricle ratio are routinely used for risk stratification. Paucity of intraparenchymal blood vessels has previously been described, but their association with clinical biomarkers and outcomes has not been studied. We sought to determine if small vascular volumes measured on computed tomography scans were associated with an abnormal RV on echocardiography and mortality. We hypothesized that decreased small venous volume would be associated with greater RV dysfunction and increased mortality. METHODS A retrospective cohort of patients with intermediate risk pulmonary embolism admitted to Brigham and Women's Hospital between 2009 and 2017 was assembled, and clinical and radiographic data were obtained. We performed 3-dimensional reconstructions of vasculature to assess intraparenchymal vascular volumes. Statistical analyses were performed using multivariable regression and cox proportional hazards models, adjusting for age, sex, lung volume, and small arterial volume. RESULTS Seven hundred twenty-two subjects were identified of whom 573 had documented echocardiography. A 50% reduction in small venous volume was associated with an increased risk of RV dilation (relative risk: 1.38 [95% CI, 1.18-1.63], P<0.001), RV dysfunction (relative risk: 1.62 [95% CI, 1.36-1.95], P<0.001), and RV strain (relative risk: 1.67 [95% CI, 1.37-2.04], P<0.001); increased cardiac biomarkers, and higher 30-day and 90-day mortality (hazard ratio: 2.50 [95% CI, 1.33-4.67], P=0.004 and hazard ratio: 1.84 [95% CI, 1.11-3.04], P=0.019, respectively). CONCLUSIONS Loss of small venous volume quantified from computed tomography angiography is associated with increased risk of abnormal RV on echocardiography, abnormal cardiac biomarkers, and higher risk of 30- and 90-day mortality. Small venous volume may be a useful marker for assessing disease severity in acute pulmonary embolism.
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Affiliation(s)
- Jasleen Minhas
- Division of Pulmonary, Allergy and Critical Care (J.M., N.A.-N., S.M.K.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Pietro Nardelli
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Syed Moin Hassan
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Nadine Al-Naamani
- Division of Pulmonary, Allergy and Critical Care (J.M., N.A.-N., S.M.K.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Eileen Harder
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Samuel Ash
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Gonzalo Vegas Sánchez-Ferrero
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Stefanie Mason
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Andetta R Hunsaker
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Gregory Piazza
- Division of Cardiovascular Medicine (G.P., S.Z.G.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine (G.P., S.Z.G.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Aaron B Waxman
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Steven M Kawut
- Division of Pulmonary, Allergy and Critical Care (J.M., N.A.-N., S.M.K.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Raúl San José Estépar
- Department of Radiology (P.N., G.V.S.-F., A.R.H., R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - George R Washko
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Farbod N Rahaghi
- University of Pennsylvania, Philadelphia. Division of Pulmonary and Critical Care Medicine (S.M.H., E.H., S.A., S.M., A.B.W., G.R.W., F.N.R.), Brigham and Women's Hospital, Harvard Medical School, Boston
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14
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Pistenmaa CL, Nardelli P, Ash SY, Come CE, Diaz AA, Rahaghi FN, Barr RG, Young KA, Kinney GL, Simmons JP, Wade RC, Wells JM, Hokanson JE, Washko GR, San José Estépar R. Pulmonary Arterial Pruning and Longitudinal Change in Percent Emphysema and Lung Function: The Genetic Epidemiology of COPD Study. Chest 2021; 160:470-480. [PMID: 33607083 PMCID: PMC8411454 DOI: 10.1016/j.chest.2021.01.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/28/2020] [Accepted: 01/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pulmonary endothelial damage has been shown to precede the development of emphysema in animals, and vascular changes in humans have been observed in COPD and emphysema. RESEARCH QUESTION Is intraparenchymal vascular pruning associated with longitudinal progression of emphysema on CT imaging or decline in lung function over 5 years? STUDY DESIGN AND METHODS The Genetic Epidemiology of COPD Study enrolled ever smokers with and without COPD from 2008 through 2011. The percentage of emphysema-like lung, or "percent emphysema," was assessed at baseline and after 5 years on noncontrast CT imaging as the percentage of lung voxels < -950 Hounsfield units. An automated CT imaging-based tool assessed and classified intrapulmonary arteries and veins. Spirometry measures are postbronchodilator. Pulmonary arterial pruning was defined as a lower ratio of small artery volume (< 5 mm2 cross-sectional area) to total lung artery volume. Mixed linear models included demographics, anthropomorphics, smoking, and COPD, with emphysema models also adjusting for CT imaging scanner and lung function models adjusting for clinical center and baseline percent emphysema. RESULTS At baseline, the 4,227 participants were 60 ± 9 years of age, 50% were women, 28% were Black, 47% were current smokers, and 41% had COPD. Median percent emphysema was 2.1 (interquartile range, 0.6-6.3) and progressed 0.24 percentage points/y (95% CI, 0.22-0.26 percentage points/y) over 5.6 years. Mean FEV1 to FVC ratio was 68.5 ± 14.2% and declined 0.26%/y (95% CI, -0.30 to -0.23%/y). Greater pulmonary arterial pruning was associated with more rapid progression of percent emphysema (0.11 percentage points/y per 1-SD increase in arterial pruning; 95% CI, 0.09-0.16 percentage points/y), including after adjusting for baseline percent emphysema and FEV1. Arterial pruning also was associated with a faster decline in FEV1 to FVC ratio (-0.04%/y per 1-SD increase in arterial pruning; 95% CI, -0.008 to -0.001%/y). INTERPRETATION Pulmonary arterial pruning was associated with faster progression of percent emphysema and more rapid decline in FEV1 to FVC ratio over 5 years in ever smokers, suggesting that pulmonary vascular differences may be relevant in disease progression. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
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Affiliation(s)
| | - P Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - S Y Ash
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - C E Come
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - A A Diaz
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - F N Rahaghi
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - R G Barr
- Departments of Medicine and Epidemiology, Columbia University, New York, NY
| | - K A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - G L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - J P Simmons
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - R C Wade
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - J M Wells
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - J E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - G R Washko
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
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15
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Rahaghi FN, Nardelli P, Harder E, Singh I, Sanchez-Ferrero GV, Ross JC, San José Estépar R, Ash SY, Hunsaker AR, Maron BA, Leopold JA, Waxman AB, San José Estépar R, Washko GR. Quantification of Arterial and Venous Morphological Markers in Pulmonary Arterial Hypertension Using Computed Tomography. Chest 2021; 160:2220-2231. [PMID: 34270966 PMCID: PMC8692106 DOI: 10.1016/j.chest.2021.06.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/25/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Pulmonary hypertension is a heterogeneous disease, and a significant portion of patients at risk for it have CT imaging available. Advanced automated processing techniques could be leveraged for early detection, screening, and development of quantitative phenotypes. Pruning and vascular tortuosity have been previously described in pulmonary arterial hypertension (PAH), but the extent of these phenomena in arterial vs venous pulmonary vasculature and in exercise pulmonary hypertension (ePH) have not been described. Research Question What are the arterial and venous manifestations of pruning and vascular tortuosity using CT imaging in PAH, and do they also occur in ePH? Study Design and Methods A cohort of patients with PAH and ePH and control subjects with available CT angiograms were retrospectively identified to examine the differential arterial and venous presence of pruning and tortuosity in patients with precapillary pulmonary hypertension not confounded by lung or thromboembolic disease. The pulmonary vasculature was reconstructed, and an artificial intelligence method was used to separate arteries and veins and to compute arterial and venous vascular volumes and tortuosity. Results A total of 42 patients with PAH, 12 patients with ePH, and 37 control subjects were identified. There was relatively lower (median [interquartile range]) arterial small vessel volume in subjects with PAH (PAH 14.7 [11.7-16.5; P < .0001]) vs control subjects (16.9 [15.6-19.2]) and venous small vessel volume in subjects with PAH and ePH (PAH 8.0 [6.5-9.6; P < .0001]; ePH, 7.8 [7.5-11.4; P = .004]) vs control subjects (11.5 [10.6-12.2]). Higher large arterial volume, however, was only observed in the pulmonary arteries (PAH 17.1 [13.6-23.4; P < .0001] vs control subjects 11.4 [8.1-15.4]). Similarly, tortuosity was higher in the pulmonary arteries in the PAH group (PAH 3.5 [3.3-3.6; P = .0002] vs control 3.2 [3.2-3.3]). Interpretation Lower small distal pulmonary vascular volume, higher proximal arterial volume, and higher arterial tortuosity were observed in PAH. These can be quantified by using automated techniques from clinically acquired CT scans of patients with ePH and resting PAH.
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Affiliation(s)
- Farbod N Rahaghi
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US.
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Eileen Harder
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Inderjit Singh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | | | - James C Ross
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Rubén San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Samuel Y Ash
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Aaron B Waxman
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
| | - George R Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA/US
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16
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Sweatt AJ, Reddy R, Rahaghi FN, Al-Naamani N. What's new in pulmonary hypertension clinical research: lessons from the best abstracts at the 2020 American Thoracic Society International Conference. Pulm Circ 2021; 11:20458940211040713. [PMID: 34471517 PMCID: PMC8404658 DOI: 10.1177/20458940211040713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
In this conference paper, we review the 2020 American Thoracic Society International Conference session titled, "What's New in Pulmonary Hypertension Clinical Research: Lessons from the Best Abstracts". This virtual mini-symposium took place on 21 October 2020, in lieu of the annual in-person ATS International Conference which was cancelled due to the COVID-19 pandemic. Seven clinical research abstracts were selected for presentation in the session, which encompassed five major themes: (1) standardizing diagnosis and management of pulmonary hypertension, (2) improving risk assessment in pulmonary arterial hypertension, (3) evaluating biomarkers of disease activity, (4) understanding metabolic dysregulation across the spectrum of pulmonary hypertension, and (5) advancing knowledge in chronic thromboembolic pulmonary hypertension. Focusing on these five thematic contexts, we review the current state of knowledge, summarize presented research abstracts, appraise their significance and limitations, and then discuss relevant future directions in pulmonary hypertension clinical research.
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Affiliation(s)
- Andrew J. Sweatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
| | - Raju Reddy
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Farbod N. Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nadine Al-Naamani
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - on behalf of the American Thoracic Society Pulmonary Circulation Assembly Early Career Working Group
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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17
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Rahaghi FN, Hilton JF, Corrêa RA, Loureiro C, Ota-Arakaki JS, Verrastro CGY, Lee MH, Mickael C, Nardelli P, Systrom DA, Waxman AB, Washko GR, San José Estépar R, Graham BB, Oliveira RKF. Arterial vascular volume changes with haemodynamics in schistosomiasis-associated pulmonary arterial hypertension. Eur Respir J 2021; 57:2003914. [PMID: 33446601 PMCID: PMC8106660 DOI: 10.1183/13993003.03914-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/19/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joan F Hilton
- Dept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Ricardo A Corrêa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Jaquelina S Ota-Arakaki
- Division of Respiratory Diseases, Dept of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Michael H Lee
- Pulmonary Sciences and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Claudia Mickael
- Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz medical campus, Aurora, CO, USA
| | - Pietro Nardelli
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Systrom
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian B Graham
- Pulmonary Sciences and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rudolf K F Oliveira
- Division of Respiratory Diseases, Dept of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Ash SY, San José Estépar R, Fain SB, Tal-Singer R, Stockley RA, Nordenmark LH, Rennard S, Han MK, Merrill D, Humphries SM, Diaz AA, Mason SE, Rahaghi FN, Pistenmaa CL, Sciurba FC, Vegas-Sánchez-Ferrero G, Lynch DA, Washko GR. Relationship between Emphysema Progression at CT and Mortality in Ever-Smokers: Results from the COPDGene and ECLIPSE Cohorts. Radiology 2021; 299:222-231. [PMID: 33591891 PMCID: PMC7997617 DOI: 10.1148/radiol.2021203531] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The relationship between emphysema progression and long-term outcomes is unclear. Purpose To determine the relationship between emphysema progression at CT and mortality among participants with emphysema. Materials and Methods In a secondary analysis of two prospective observational studies, COPDGene (clinicaltrials.gov, NCT00608764) and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE; clinicaltrials.gov, NCT00292552), emphysema was measured at CT at two points by using the volume-adjusted lung density at the 15th percentile of the lung density histogram (hereafter, lung density perc15) method. The association between emphysema progression rate and all-cause mortality was analyzed by using Cox regression adjusted for ethnicity, sex, baseline age, pack-years, and lung density, baseline and change in smoking status, forced expiratory volume in 1 second, and 6-minute walk distance. In COPDGene, respiratory mortality was analyzed by using the Fine and Gray method. Results A total of 5143 participants (2613 men [51%]; mean age, 60 years ± 9 [standard deviation]) in COPDGene and 1549 participants (973 men [63%]; mean age, 62 years ± 8) in ECLIPSE were evaluated, of which 2097 (40.8%) and 1179 (76.1%) had emphysema, respectively. Baseline imaging was performed between January 2008 and December 2010 for COPDGene and January 2006 and August 2007 for ECLIPSE. Follow-up imaging was performed after 5.5 years ± 0.6 in COPDGene and 3.0 years ± 0.2 in ECLIPSE, and mortality was assessed over the ensuing 5 years in both. For every 1 g/L per year faster rate of decline in lung density perc15, all-cause mortality increased by 8% in COPDGene (hazard ratio [HR], 1.08; 95% CI: 1.01, 1.16; P = .03) and 6% in ECLIPSE (HR, 1.06; 95% CI: 1.00, 1.13; P = .045). In COPDGene, respiratory mortality increased by 22% (HR, 1.22; 95% CI: 1.13, 1.31; P < .001) for the same increase in the rate of change in lung density perc15. Conclusion In ever-smokers with emphysema, emphysema progression at CT was associated with increased all-cause and respiratory mortality. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lee and Park in this issue.
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Affiliation(s)
- Samuel Y Ash
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Sean B Fain
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Ruth Tal-Singer
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Robert A Stockley
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Lars H Nordenmark
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Stephen Rennard
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - MeiLan K Han
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Debora Merrill
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Stephen M Humphries
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Alejandro A Diaz
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Stefanie E Mason
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Farbod N Rahaghi
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Carrie L Pistenmaa
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Frank C Sciurba
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - Gonzalo Vegas-Sánchez-Ferrero
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - David A Lynch
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
| | - George R Washko
- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
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- From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., S.E.M., F.N.R., C.L.P., G.R.W.), Applied Chest Imaging Laboratory (S.Y.A., R.S.J.E., A.A.D., S.E.M., F.N.R., C.L.P., G.V.S.F., G.R.W.), and Department of Radiology (R.S.J.E., G.V.S.F.), Brigham and Women's Hospital, 75 Francis St, PBB, CA-3, Boston, MA 02130; Departments of Biomedical Engineering and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (S.B.F.); COPD Foundation, Washington, DC (R.T.S., D.M.); Lung Investigation Unit, Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, England (R.A.S.); Respiratory and Inflammation Therapy Area, Clinical Development, AstraZeneca, Mölndal, Sweden (L.H.N.); Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich (M.K.H.); Department of Radiology, National Jewish Health, Denver, Colo (S.M.H., D.A.L.); and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (F.C.S.)
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Mason SE, Zhu J, Rahaghi FN, Washko GR, Pandya A. Cost-effectiveness microsimulation of catheter-directed thrombolysis in submassive pulmonary embolism using a right ventricular function model. J Thromb Thrombolysis 2021; 49:673-680. [PMID: 32048167 DOI: 10.1007/s11239-020-02058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Approximately 30-50% of hemodynamically stable patients presenting with acute pulmonary embolism (PE) have evidence of right ventricular (RV) dysfunction. These patients are classified as submassive PE and the role of reperfusion therapy remains unclear. We sought to identify the circumstances under which catheter-directed thrombolysis (CDT) would represent high-value care for submassive PE. We used a computer-based, individual-level, state-transition model with one million simulated patients to perform a cost-effectiveness analysis comparing the treatment of submassive PE with CDT followed by anticoagulation to treatment with anticoagulation alone. Because RV function impacts prognosis and is commonly used in PE outcomes research, our model used RV dysfunction to differentiate health states. One-way, two-way, and probabilistic sensitivity analyses were used to quantify model uncertainty. Our base case analysis generated an incremental cost-effectiveness ratio (ICER) of $119,326 per quality adjusted life year. Sensitivity analyses resulted in ICERs consistent with high-value care when CDT conferred a reduction in the absolute probability of RV dysfunction of 3.5% or more. CDT yielded low-value ICERs if the absolute reduction was less than 1.56%. Our model suggests that catheter-directed thrombolytics represents high-value care compared to anticoagulation alone when CDT offers an absolute improvement in RV dysfunction of 3.5% or more, but there is substantial uncertainly around these results. We estimated the monetary value of clarifying the costs and consequences surrounding RV dysfunction after submassive PE to be approximately $268 million annually, suggesting further research in this area could be highly valuable.
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Affiliation(s)
- Stefanie E Mason
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Center for Chest Diseases, Brigham and Women's Hospital, 15 Francis St, Boston, MA, 02115, USA.
| | - Jinyi Zhu
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Center for Chest Diseases, Brigham and Women's Hospital, 15 Francis St, Boston, MA, 02115, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Center for Chest Diseases, Brigham and Women's Hospital, 15 Francis St, Boston, MA, 02115, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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20
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Harder EM, Vanderpool R, Rahaghi FN. Advanced Imaging in Pulmonary Vascular Disease. Clin Chest Med 2021; 42:101-112. [PMID: 33541604 DOI: 10.1016/j.ccm.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although the diagnosis of pulmonary hypertension requires invasive testing, imaging serves an important role in the screening, classification, and monitoring of patients with pulmonary vascular disease (PVD). The development of advanced imaging techniques has led to improvements in the understanding of disease pathophysiology, noninvasive assessment of hemodynamics, and stratification of patient risk. This article discusses the current role of advanced imaging and the emerging novel techniques for visualizing the lung parenchyma, mediastinum, and heart in PVD.
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Affiliation(s)
- Eileen M Harder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
| | - Rebecca Vanderpool
- Division of Translational and Regenerative Medicine, Department of Medicine, University of Arizona, 1656 East Mabel Street, Tucson, AZ 85721, USA. https://twitter.com/rrvdpool
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
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21
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Washko GR, Nardelli P, Ash SY, Rahaghi FN, Vegas Sanchez-Ferrero G, Come CE, Dransfield MT, Kalhan R, Han MK, Bhatt SP, Wells JM, Pistenmaa CL, Diaz AA, Ross JC, Rennard S, Querejeta Roca G, Shah AM, Young K, Kinney GL, Hokanson JE, Agustí A, San José Estépar R. Smaller Left Ventricle Size at Noncontrast CT Is Associated with Lower Mortality in COPDGene Participants. Radiology 2020; 296:208-215. [PMID: 32368963 PMCID: PMC7299752 DOI: 10.1148/radiol.2020191793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LVEV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LVEV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LVEV, distal pulmonary venous blood volume for vessels smaller than 5 mm2 in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LVEV as well as the association of LVEV with health status using the St George's Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results The median age of the cohort was 64 years (interquartile range, 57-70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LVEV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men (P < .001 for both). In fully adjusted models, higher emphysema percentage (β = -4.2; 95% confidence interval [CI]: -5.0, -3.4; P < .001), venous BV5 (β = 7.0; 95% CI: 5.7, 8.2; P < .001), and pectoralis muscle area (β = 2.7; 95% CI: 1.2, 4.1; P < .001) were independently associated with reduced LVEV. Reductions in LVEV were associated with improved health status (β = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (β = -12.2; 95% CI: -15.2, -9.3). These effects were greater in women than in men. The effect of reduced LVEV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- George R Washko
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Pietro Nardelli
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Samuel Y Ash
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Farbod N Rahaghi
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Carolyn E Come
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Mark T Dransfield
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Ravi Kalhan
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - MeiLan K Han
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Surya P Bhatt
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - J Michael Wells
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Carrie L Pistenmaa
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Alejandro A Diaz
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - James C Ross
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Stephen Rennard
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Gabriela Querejeta Roca
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Amil M Shah
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Kendra Young
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Gregory L Kinney
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - John E Hokanson
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Alvar Agustí
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | -
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
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22
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LaFon DC, Bhatt SP, Labaki WW, Rahaghi FN, Moll M, Bowler RP, Regan EA, Make BJ, Crapo JD, San Jose Estepar R, Diaz AA, Silverman EK, Han MK, Hobbs B, Cho MH, Washko GR, Dransfield MT, Wells JM. Pulmonary artery enlargement and mortality risk in moderate to severe COPD: results from COPDGene. Eur Respir J 2020; 55:13993003.01812-2019. [PMID: 31772001 DOI: 10.1183/13993003.01812-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/23/2019] [Indexed: 11/05/2022]
Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,UAB Lung Health Center, Birmingham, AL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,UAB Lung Imaging Core, Birmingham, AL, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russ P Bowler
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Division of Rheumatology, Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian Hobbs
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,UAB Lung Health Center, Birmingham, AL, USA.,Birmingham VA Medical Center, Birmingham, AL, USA
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23
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Rahaghi FN, San José Estépar R, Goldhaber SZ, Minhas JK, Nardelli P, Vegas Sanchez-Ferrero G, De La Bruere I, Hassan SM, Mason S, Ash SY, Come CE, Washko GR, Piazza G. Quantification and Significance of Pulmonary Vascular Volume in Predicting Response to Ultrasound-Facilitated, Catheter-Directed Fibrinolysis in Acute Pulmonary Embolism (SEATTLE-3D). Circ Cardiovasc Imaging 2019; 12:e009903. [PMID: 31842589 DOI: 10.1161/circimaging.119.009903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Farbod N Rahaghi
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Department of Radiology (R.S.J.E., P.N., G.V.S.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine (S.Z.G., G.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jasleen K Minhas
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pietro Nardelli
- Applied Chest Imaging Laboratory, Department of Radiology (R.S.J.E., P.N., G.V.S.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gonzalo Vegas Sanchez-Ferrero
- Applied Chest Imaging Laboratory, Department of Radiology (R.S.J.E., P.N., G.V.S.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Isaac De La Bruere
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Syed M Hassan
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stefanie Mason
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Samuel Y Ash
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Carolyn E Come
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - George R Washko
- Pulmonary and Critical Care Medicine (F.N.R., J.K.M., I.D.L.B., S.M.H., S.M., S.Y.A., C.E.C., G.R.W.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gregory Piazza
- Division of Cardiovascular Medicine (S.Z.G., G.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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24
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Ash SY, Sanchez-Ferrero GV, Schiebler ML, Rahaghi FN, Rai A, Come CE, Ross JC, Colon AG, Cardet JC, Bleecker ER, Castro M, Fahy JV, Fain SB, Gaston BM, Hoffman EA, Jarjour NN, Lempel JK, Mauger DT, Tattersall MC, Wenzel SE, Levy BD, Washko GR, Israel E, San Jose Estepar R. Estimated Ventricular Size, Asthma Severity, and Exacerbations: The Severe Asthma Research Program III Cohort. Chest 2019; 157:258-267. [PMID: 31521672 DOI: 10.1016/j.chest.2019.08.2185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/25/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Relative enlargement of the pulmonary artery (PA) on chest CT imaging is associated with respiratory exacerbations in patients with COPD or cystic fibrosis. We sought to determine whether similar findings were present in patients with asthma and whether these findings were explained by differences in ventricular size. METHODS We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left, and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI, and eETVVI, respectively). Associations between the cardiac and PA measures (PA-to-aorta [PA/A] ratio, eERVVI-to-eELVVI [eRV/eLV] ratio, eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed by Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated by multivariable linear and zero-inflated negative binomial regression. RESULTS Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m2 smaller eETVVI than healthy control subjects (P = .003) and 14.1 mL/m2 smaller eETVVI than those with mild/moderate disease (P = .011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example, those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow-up than those with eETVVI greater than the median (P = .020). Neither PA/A nor eRV/eLV was associated with asthma severity or exacerbations. CONCLUSIONS In patients with asthma, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01761630; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | | | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Ashish Rai
- Department of Medicine, North Shore Medical Center, Salem, MA
| | - Carolyn E Come
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Alysha G Colon
- College of Medicine, University of Florida, Gainesville, FL
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, FL
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, AZ
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO
| | - John V Fahy
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA
| | - Sean B Fain
- Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Benjamin M Gaston
- Division of Pulmonology, Allergy, and Immunology, and Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, OH
| | - Eric A Hoffman
- Departments of Radiology, Biomedical Engineering, and Medicine, University of Iowa, Iowa City, IA
| | - Nizar N Jarjour
- Division of Pulmonary and Critical Care Medicine (Dr Jarjour), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jason K Lempel
- Department of Radiology, Cleveland Clinic, Cleveland, OH
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Penn State Eberly College of Science, University Park, PA
| | - Matthew C Tattersall
- Division of Cardiovascular Medicine (Dr Tattersall), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Bruce D Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
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25
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Wardi G, Joel I, Villar J, Lava M, Gross E, Tolia V, Seethala RR, Owens RL, Sell RE, Montesi SB, Rahaghi FN, Bose S, Rai A, Stevenson EK, McSparron J, Tolia V, Beitler JR. Equipoise in Appropriate Initial Volume Resuscitation for Patients in Septic Shock With Heart Failure: Results of a Multicenter Clinician Survey. J Intensive Care Med 2019; 35:1338-1345. [PMID: 31446829 DOI: 10.1177/0885066619871247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE International clinical practice guidelines call for initial volume resuscitation of at least 30 mL/kg body weight for patients with sepsis-induced hypotension or shock. Although not considered in the guidelines, preexisting cardiac dysfunction may be an important factor clinicians weigh in deciding the quantity of volume resuscitation for patients with septic shock. METHODS We conducted a multicenter survey of clinicians who routinely treat patients with sepsis to evaluate their beliefs, behaviors, knowledge, and perceived structural barriers regarding initial volume resuscitation for patients with sepsis and concomitant heart failure with reduced ejection fraction (HFrEF) <40%. Initial volume resuscitation preferences were captured as ordinal values, and additional testing for volume resuscitation preferences was performed using McNemar and Wilcoxon signed rank tests as indicated. Univariable logistic regression models were used to identify significant predictors of ≥30 mL/kg fluid administration. RESULTS A total of 317 clinicians at 9 US hospitals completed the survey (response rate 47.3%). Most respondents were specialists in either internal medicine or emergency medicine. Substantial heterogeneity was found regarding sepsis resuscitation preferences for patients with concomitant HFrEF. The belief that patients with septic shock and HFrEF should be exempt from current sepsis bundle initiatives was shared by 39.4% of respondents. A minimum fluid challenge of ∼30 mL/kg or more was deemed appropriate in septic shock by only 56.4% of respondents for patients with concomitant HFrEF, compared to 89.1% of respondents for patients without HFrEF (P < .01). Emergency medicine physicians were most likely to feel that <30 mL/kg was most appropriate in patients with septic shock and HFrEF. CONCLUSIONS Clinical equipoise exists regarding initial volume resuscitation for patients with sepsis-induced hypotension or shock and concomitant HFrEF. Future studies and clinical practice guidelines should explicitly address resuscitation in this subpopulation.
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Affiliation(s)
- Gabriel Wardi
- Department of Emergency Medicine, 8784University of California, San Diego, CA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Ian Joel
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Julian Villar
- Department of Emergency Medicine, Kaiser Oakland, CA, USA
| | - Michael Lava
- 194441Wellstar Medical Group Pulmonary Medicine, Marietta, GA, USA
| | - Eric Gross
- Department of Emergency Medicine, 8784University of California, Davis, CA, USA
| | - Vaishal Tolia
- Department of Emergency Medicine, 8784University of California, San Diego, CA, USA
| | - Raghu R Seethala
- Department of Emergency Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Rebecca E Sell
- Division of Pulmonary, Critical Care, and Sleep Medicine, 8784University of California, San Diego, CA, USA
| | - Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Somnath Bose
- Department of Anesthesia, Critical Care, and Pain Medicine, 1859Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashish Rai
- Department of Pulmonary, Critical Care, and Sleep Medicine, 25218North Shore Medical Center, MA, USA
| | - Elizabeth K Stevenson
- Department of Pulmonary, Critical Care, and Sleep Medicine, 25218North Shore Medical Center, MA, USA
| | - Jakob McSparron
- Division of Pulmonary and Critical Care Medicine, 1259University of Michigan, Ann Arbor, MI, USA
| | - Vaishal Tolia
- Department of Emergency Medicine, 8784University of California, San Diego, CA, USA
| | - Jeremy R Beitler
- Center for Acute Respiratory Failure and Division of Pulmonary, Allergy, and Critical Care Medicine, 5798Columbia University, New York, NY
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26
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Washko GR, Nardelli P, Ash SY, Vegas Sanchez-Ferrero G, Rahaghi FN, Come CE, Dransfield MT, Kalhan R, Han MK, Bhatt SP, Wells JM, Aaron CP, Diaz AA, Ross JC, Cuttica MJ, Labaki WW, Querejeta Roca G, Shah AM, Young K, Kinney GL, Hokanson JE, Agustí A. Arterial Vascular Pruning, Right Ventricular Size, and Clinical Outcomes in Chronic Obstructive Pulmonary Disease. A Longitudinal Observational Study. Am J Respir Crit Care Med 2019; 200:454-461. [PMID: 30758975 PMCID: PMC6701031 DOI: 10.1164/rccm.201811-2063oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023] Open
Abstract
Rationale: Cor pulmonale (right ventricular [RV] dilation) and cor pulmonale parvus (RV shrinkage) are both described in chronic obstructive pulmonary disease (COPD). The identification of emphysema as a shared risk factor suggests that additional disease characterization is needed to understand these widely divergent cardiac processes.Objectives: To explore the relationship between computed tomography measures of emphysema and distal pulmonary arterial morphology with RV volume, and their association with exercise capacity and mortality in ever-smokers with COPD enrolled in the COPDGene Study.Methods: Epicardial (myocardium and chamber) RV volume (RVEV), distal pulmonary arterial blood vessel volume (arterial BV5: vessels <5 mm2 in cross-section), and objective measures of emphysema were extracted from 3,506 COPDGene computed tomography scans. Multivariable linear and Cox regression models and the log-rank test were used to explore the association between emphysema, arterial BV5, and RVEV with exercise capacity (6-min-walk distance) and all-cause mortality.Measurements and Main Results: The RVEV was approximately 10% smaller in Global Initiative for Chronic Obstructive Lung Disease stage 4 versus stage 1 COPD (P < 0.0001). In multivariable modeling, a 10-ml decrease in arterial BV5 (pruning) was associated with a 1-ml increase in RVEV. For a given amount of emphysema, relative preservation of the arterial BV5 was associated with a smaller RVEV. An increased RVEV was associated with reduced 6-minute-walk distance and in those with arterial pruning an increased mortality.Conclusions: Pulmonary arterial pruning is associated with clinically significant increases in RV volume in smokers with COPD and is related to exercise capacity and mortality in COPD.Clinical trial registered with www.clinicaltrials.gov (NCT00608764).
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Affiliation(s)
| | | | - Samuel Y. Ash
- Division of Pulmonary and Critical Care, Department of Medicine
| | | | | | - Carolyn E. Come
- Division of Pulmonary and Critical Care, Department of Medicine
| | - Mark T. Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ravi Kalhan
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Surya P. Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - J. Michael Wells
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - James C. Ross
- Applied Chest Imaging Laboratory, Department of Radiology
| | - Michael J. Cuttica
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Amil M. Shah
- Division of Cardiovascular, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | | | - for the COPDGene Investigators
- Division of Pulmonary and Critical Care, Department of Medicine
- Applied Chest Imaging Laboratory, Department of Radiology
- Department of Anesthesia, and
- Division of Cardiovascular, Brigham and Women’s Hospital, Boston, Massachusetts
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
- Hospital Clinic Barcelona, Barcelona, Spain
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27
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Rahaghi FN, Argemí G, Nardelli P, Domínguez-Fandos D, Arguis P, Peinado VI, Ross JC, Ash SY, de La Bruere I, Come CE, Diaz AA, Sánchez M, Washko GR, Barberà JA, San José Estépar R. Pulmonary vascular density: comparison of findings on computed tomography imaging with histology. Eur Respir J 2019; 54:1900370. [PMID: 31196942 PMCID: PMC7007984 DOI: 10.1183/13993003.00370-2019] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 05/11/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exposure to cigarette smoke has been shown to lead to vascular remodelling. Computed tomography (CT) imaging measures of vascular pruning have been associated with pulmonary vascular disease, an important morbidity associated with smoking. In this study we compare CT-based measures of distal vessel loss to histological vascular and parenchymal changes. METHODS A retrospective review of 80 patients who had undergone lung resection identified patients with imaging appropriate for three-dimensional (3D) vascular reconstruction (n=18) and a second group for two-dimensional (2D) analysis (n=19). Measurements of the volume of the small vessels (3D) and the cross-sectional area of the small vessels (<5 mm2 cross-section) were computed. Histological measures of cross-sectional area of the vasculature and loss of alveoli septa were obtained for all subjects. RESULTS The 2D cross-sectional area of the vasculature on CT imaging was associated with the histological vascular cross-sectional area (r=0.69; p=0.001). The arterial small vessel volume assessed by CT correlated with the histological vascular cross-sectional area (r=0.50; p=0.04), a relationship that persisted even when adjusted for CT-derived measures of emphysema in a regression model. CONCLUSIONS Loss of small vessel volume in CT imaging of smokers is associated with histological loss of vascular cross-sectional area. Imaging-based quantification of pulmonary vasculature provides a noninvasive method to study the multiscale effects of smoking on the pulmonary circulation.
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Affiliation(s)
- Farbod N Rahaghi
- Pulmonary and Critical Care Division, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Equal contributors on this article
| | - Gemma Argemí
- Dept of Pulmonary Medicine, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Equal contributors on this article
| | - Pietro Nardelli
- Dept of Radiology, Harvard School of Medicine, Boston, MA, USA
| | - David Domínguez-Fandos
- Dept of Pulmonary Medicine, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Arguis
- Dept of Radiology, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Víctor I Peinado
- Dept of Pulmonary Medicine, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center for Respiratory Diseases (CIBERES), Madrid Spain
| | - James C Ross
- Dept of Radiology, Harvard School of Medicine, Boston, MA, USA
| | - Samuel Y Ash
- Pulmonary and Critical Care Division, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Isaac de La Bruere
- Pulmonary and Critical Care Division, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Carolyn E Come
- Pulmonary and Critical Care Division, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro A Diaz
- Pulmonary and Critical Care Division, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Sánchez
- Dept of Radiology, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - George R Washko
- Pulmonary and Critical Care Division, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Equal contributors on this article
| | - Joan Albert Barberà
- Dept of Pulmonary Medicine, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center for Respiratory Diseases (CIBERES), Madrid Spain
- Equal contributors on this article
| | - Raúl San José Estépar
- Pulmonary and Critical Care Division, Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Equal contributors on this article
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28
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Singh I, Rahaghi FN, Naeije R, Oliveira RKF, Vanderpool RR, Waxman AB, Systrom DM. Dynamic right ventricular-pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension. Pulm Circ 2019; 9:2045894019862435. [PMID: 31218910 PMCID: PMC6643191 DOI: 10.1177/2045894019862435] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Despite recent advances, the prognosis of pulmonary hypertension (PH) remains poor. While the initial insult in PH implicates the pulmonary vasculature, the functional state, exercise capacity, and survival of such patients are closely linked to right ventricular (RV) function. In the current study, we sought to investigate the effects of maximum incremental exercise on the matching of RV contractility and afterload (i.e. right ventricular-pulmonary arterial [RV-PA] coupling) in patients with exercise PH (ePH) and pulmonary arterial hypertension (PAH). End-systolic elastance (Ees), pulmonary arterial elastance (Ea), and RV-PA coupling (Ees/Ea) were determined using single-beat pressure-volume loop analysis in 40 patients that underwent maximum invasive cardiopulmonary exercise testing. Eleven patients had ePH, nine had PAH, and 20 were age-matched controls. During exercise, the impaired exertional contractile reserve in PAH was associated with blunted stroke volume index (SVI) augmentation and reduced peak oxygen consumption (peak VO2 %predicted). Compared to PAH, ePH demonstrated increased RV contractility in response to increasing RV afterload during exercise; however, this was insufficient and resulted in reduced peak RV-PA coupling. The dynamic RV-PA uncoupling in ePH was associated with similarly blunted SVI augmentation and peak VO2 as PAH. In conclusion, dynamic rest-to-peak exercise RV-PA uncoupling during maximum exercise blunts SV increase and reduces exercise capacity in exercise PH and PAH. In ePH, the insufficient increase in RV contractility to compensate for increasing RV afterload during maximum exercise leads to deterioration of RV-PA coupling. These data provide evidence that even in the early stages of PH, RV function is compromised.
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Affiliation(s)
- Inderjit Singh
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Farbod N Rahaghi
- 2 Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert Naeije
- 3 Department of Pathophysiology, Erasmsus Campus, Brussels, Belgium
| | - Rudolf K F Oliveira
- 4 Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | | | - Aaron B Waxman
- 2 Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - David M Systrom
- 2 Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Singh I, Oliveira RKF, Naeije R, Rahaghi FN, Oldham WM, Systrom DM, Waxman AB. Pulmonary Vascular Distensibility and Early Pulmonary Vascular Remodeling in Pulmonary Hypertension. Chest 2019; 156:724-732. [PMID: 31121149 DOI: 10.1016/j.chest.2019.04.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Exercise stress testing of the pulmonary circulation may uncover decreased pulmonary vascular (PV) distensibility as a cause of impaired aerobic exercise capacity and right ventricular (RV)-pulmonary arterial (PA) uncoupling. As such, it may help in the differential diagnosis of unexplained dyspnea, including pulmonary hypertension (PH) and/or heart failure with preserved ejection fraction (HFpEF). We investigated rest and exercise invasive pulmonary hemodynamics, ventilation, and gas exchange in patients with unexplained dyspnea, including 44 patients with HFpEF (of whom 20 had a normal pulmonary vascular resistance [PVR] during exercise [ie, passive HFpEF] and 24 had a higher than normal exercise PVR), 22 patients with exercise PH, 19 patients with pulmonary arterial hypertension (PAH), and 24 age- and sex-matched normal control subjects. METHODS A PV distensibility coefficient α (%/mm Hg) was determined from multipoint PV pressure-flow plots. RV-PA coupling was quantified from the analysis of RV pressure curves to determine ratios of end-systolic to arterial elastances (Ees/Ea). Aerobic exercise capacity was estimated by peak oxygen consumption. RESULTS The α coefficient decreased from 1.35 ± 0.58%/mm Hg in control subjects and 1.1 ± 0.48%/mm Hg in patients with passive HFpEF to 0.62 ± 0.32%/mm Hg in exercise PH, 0.54 ± 0.27%/mm Hg in HFpEF with high exercise PVR, and 0.18 ± 0.16%/mm Hg in PAH. On multivariate analysis, PV distensibility was associated with decreased Ees/Ea and maximal volume of oxygen consumed. CONCLUSIONS PV distensibility is an early and sensitive hemodynamic marker of PV disease that is associated with RV-PA uncoupling and decreased aerobic exercise capacity.
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Affiliation(s)
- Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT
| | - Rudolf K F Oliveira
- Division of Respiratory Medicine, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Robert Naeije
- Department of Pathophysiology, Faculty of Medicine, Erasme Campus, Université Libre de Bruxelles, Brussels, Belgium
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - William M Oldham
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David M Systrom
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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30
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Singh I, Rahaghi FN, Naeije R, Oliveira RKF, Systrom DM, Waxman AB. Right Ventricular-Arterial Uncoupling During Exercise in Heart Failure With Preserved Ejection Fraction: Role of Pulmonary Vascular Dysfunction. Chest 2019; 156:933-943. [PMID: 31103695 DOI: 10.1016/j.chest.2019.04.109] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/08/2019] [Accepted: 04/29/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is associated with shortened life expectancy in heart failure with preserved ejection fraction (HFpEF). The contribution of pulmonary vascular dysfunction to RV dysfunction in HFpEF is not well understood. METHODS We investigated rest and exercise invasive pulmonary hemodynamics, ventilation, and gas exchange in 67 patients with HFpEF (of whom 28 had an abnormal pulmonary vascular response during exercise referred to as HFpEF+PVR group and 39 had a normal pulmonary vascular response during exercise referred to as HFpEF group) and in 21 matched control subjects. RESULTS Both groups of patients with HFpEF had a markedly decreased peak oxygen consumption (Vo2), decreased oxygen delivery, and impaired chronotropic response. Single beat analysis of RV pressure waveforms was used to compute the end-systolic elastance (Ees) and pulmonary arterial elastance (Ea). Right ventricular-pulmonary artery (RV-PA) coupling was measured as the ratio of Ees/Ea. Exercise was associated with a preserved Ees response but a decreased Ees/Ea in patients with HFpEF with a normal PVR response, indicating partially preserved RV contractile reserve. In HFpEF+PVR, exercise-induced increase in Ees was markedly reduced, resulting in decreased Ees/Ea and RV-PA uncoupling. Patients with HFpEF+PVR with an exercise-induced decrease in Ees/Ea had lower pulmonary artery compliance, lower peak Vo2, and lower stroke volume than patients with HFpEF. CONCLUSIONS We conclude that RV-PA uncoupling is common in HFpEF and is caused by both intrinsic RV contractile impairment and afterload mismatch. Resting and dynamic RV-PA uncoupling in HFpEF is driven by an increase in RV pulsatile rather than resistive afterload. However, with the additive effects of increased RV resistive afterload, RV-PA uncoupling worsens dynamically during exercise.
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Affiliation(s)
- Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Robert Naeije
- Department of Pathophysiology, Erasmsus Campus, Brussels, Belgium
| | - Rudolf K F Oliveira
- Division of Respiratory Medicine, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - David M Systrom
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Aaron B Waxman
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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31
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González G, Ash SY, Vegas-Sánchez-Ferrero G, Onieva Onieva J, Rahaghi FN, Ross JC, Díaz A, San José Estépar R, Washko GR. Disease Staging and Prognosis in Smokers Using Deep Learning in Chest Computed Tomography. Am J Respir Crit Care Med 2019; 197:193-203. [PMID: 28892454 DOI: 10.1164/rccm.201705-0860oc] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Deep learning is a powerful tool that may allow for improved outcome prediction. OBJECTIVES To determine if deep learning, specifically convolutional neural network (CNN) analysis, could detect and stage chronic obstructive pulmonary disease (COPD) and predict acute respiratory disease (ARD) events and mortality in smokers. METHODS A CNN was trained using computed tomography scans from 7,983 COPDGene participants and evaluated using 1,000 nonoverlapping COPDGene participants and 1,672 ECLIPSE participants. Logistic regression (C statistic and the Hosmer-Lemeshow test) was used to assess COPD diagnosis and ARD prediction. Cox regression (C index and the Greenwood-Nam-D'Agnostino test) was used to assess mortality. MEASUREMENTS AND MAIN RESULTS In COPDGene, the C statistic for the detection of COPD was 0.856. A total of 51.1% of participants in COPDGene were accurately staged and 74.95% were within one stage. In ECLIPSE, 29.4% were accurately staged and 74.6% were within one stage. In COPDGene and ECLIPSE, the C statistics for ARD events were 0.64 and 0.55, respectively, and the Hosmer-Lemeshow P values were 0.502 and 0.380, respectively, suggesting no evidence of poor calibration. In COPDGene and ECLIPSE, CNN predicted mortality with fair discrimination (C indices, 0.72 and 0.60, respectively), and without evidence of poor calibration (Greenwood-Nam-D'Agnostino P values, 0.307 and 0.331, respectively). CONCLUSIONS A deep-learning approach that uses only computed tomography imaging data can identify those smokers who have COPD and predict who are most likely to have ARD events and those with the highest mortality. At a population level CNN analysis may be a powerful tool for risk assessment.
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Affiliation(s)
- Germán González
- 1 Sierra Research, Alicante, Spain.,2 Applied Chest Imaging Laboratory, Department of Radiology, and
| | - Samuel Y Ash
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston Massachusetts
| | | | | | - Farbod N Rahaghi
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston Massachusetts
| | - James C Ross
- 2 Applied Chest Imaging Laboratory, Department of Radiology, and
| | - Alejandro Díaz
- 2 Applied Chest Imaging Laboratory, Department of Radiology, and
| | | | - George R Washko
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston Massachusetts
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32
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Kiely DG, Levin DL, Hassoun PM, Ivy D, Jone PN, Bwika J, Kawut SM, Lordan J, Lungu A, Mazurek JA, Moledina S, Olschewski H, Peacock AJ, Puri G, Rahaghi FN, Schafer M, Schiebler M, Screaton N, Tawhai M, van Beek EJ, Vonk-Noordegraaf A, Vandepool R, Wort SJ, Zhao L, Wild JM, Vogel-Claussen J, Swift AJ. EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2019; 9:2045894019841990. [PMID: 30880632 PMCID: PMC6732869 DOI: 10.1177/2045894019841990] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
| | - David L. Levin
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Paul M. Hassoun
- Department of Medicine John Hopkins
University, Baltimore, MD, USA
| | - Dunbar Ivy
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Pei-Ni Jone
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Steven M. Kawut
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jim Lordan
- Freeman Hospital, Newcastle Upon Tyne,
Newcastle, UK
| | - Angela Lungu
- Technical University of Cluj-Napoca,
Cluj-Napoca, Romania
| | - Jeremy A. Mazurek
- Division of Cardiovascular Medicine,
Hospital
of the University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Horst Olschewski
- Division of Pulmonology, Ludwig
Boltzmann Institute Lung Vascular Research, Graz, Austria
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Disease,
Unit, University of Glasgow, Glasgow, UK
| | - G.D. Puri
- Department of Anaesthesiology and
Intensive Care, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
| | - Farbod N. Rahaghi
- Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Michal Schafer
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark Schiebler
- Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Merryn Tawhai
- Auckland Bioengineering Institute,
Auckland, New Zealand
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Vandepool
- University of Arizona, Division of
Translational and Regenerative Medicine, Tucson, AZ, USA
| | - Stephen J. Wort
- Royal Brompton Hospital, London,
UK
- Imperial College, London, UK
| | | | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute of diagnostic and
Interventional Radiology, Medical Hospital Hannover, Hannover, Germany
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
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33
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Nardelli P, Jimenez-Carretero D, Bermejo-Pelaez D, Washko GR, Rahaghi FN, Ledesma-Carbayo MJ, San Jose Estepar R. Pulmonary Artery-Vein Classification in CT Images Using Deep Learning. IEEE Trans Med Imaging 2018; 37:2428-2440. [PMID: 29993996 PMCID: PMC6214740 DOI: 10.1109/tmi.2018.2833385] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Recent studies show that pulmonary vascular diseases may specifically affect arteries or veins through different physiologic mechanisms. To detect changes in the two vascular trees, physicians manually analyze the chest computed tomography (CT) image of the patients in search of abnormalities. This process is time consuming, difficult to standardize, and thus not feasible for large clinical studies or useful in real-world clinical decision making. Therefore, automatic separation of arteries and veins in CT images is becoming of great interest, as it may help physicians to accurately diagnose pathological conditions. In this paper, we present a novel, fully automatic approach to classify vessels from chest CT images into arteries and veins. The algorithm follows three main steps: first, a scale-space particles segmentation to isolate vessels; then a 3-D convolutional neural network (CNN) to obtain a first classification of vessels; finally, graph-cuts' optimization to refine the results. To justify the usage of the proposed CNN architecture, we compared different 2-D and 3-D CNNs that may use local information from bronchus- and vessel-enhanced images provided to the network with different strategies. We also compared the proposed CNN approach with a random forests (RFs) classifier. The methodology was trained and evaluated on the superior and inferior lobes of the right lung of 18 clinical cases with noncontrast chest CT scans, in comparison with manual classification. The proposed algorithm achieves an overall accuracy of 94%, which is higher than the accuracy obtained using other CNN architectures and RF. Our method was also validated with contrast-enhanced CT scans of patients with chronic thromboembolic pulmonary hypertension to demonstrate that our model generalizes well to contrast-enhanced modalities. The proposed method outperforms state-of-the-art methods, paving the way for future use of 3-D CNN for artery/vein classification in CT images.
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Ross JC, Castaldi PJ, Cho MH, Hersh CP, Rahaghi FN, Sánchez-Ferrero GV, Parker MM, Litonjua AA, Sparrow D, Dy JG, Silverman EK, Washko GR, San José Estépar R. Longitudinal Modeling of Lung Function Trajectories in Smokers with and without Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2018; 198:1033-1042. [PMID: 29671603 PMCID: PMC6221566 DOI: 10.1164/rccm.201707-1405oc] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/17/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The relationship between longitudinal lung function trajectories, chest computed tomography (CT) imaging, and genetic predisposition to chronic obstructive pulmonary disease (COPD) has not been explored. OBJECTIVES 1) To model trajectories using a data-driven approach applied to longitudinal data spanning adulthood in the Normative Aging Study (NAS), and 2) to apply these models to demographically similar subjects in the COPDGene (Genetic Epidemiology of COPD) Study with detailed phenotypic characterization including chest CT. METHODS We modeled lung function trajectories in 1,060 subjects in NAS with a median follow-up time of 29 years. We assigned 3,546 non-Hispanic white males in COPDGene to these trajectories for further analysis. We assessed phenotypic and genetic differences between trajectories and across age strata. MEASUREMENTS AND MAIN RESULTS We identified four trajectories in NAS with differing levels of maximum lung function and rate of decline. In COPDGene, 617 subjects (17%) were assigned to the lowest trajectory and had the greatest radiologic burden of disease (P < 0.01); 1,283 subjects (36%) were assigned to a low trajectory with evidence of airway disease preceding emphysema on CT; 1,411 subjects (40%) and 237 subjects (7%) were assigned to the remaining two trajectories and tended to have preserved lung function and negligible emphysema. The genetic contribution to these trajectories was as high as 83% (P = 0.02), and membership in lower lung function trajectories was associated with greater parental histories of COPD, decreased exercise capacity, greater dyspnea, and more frequent COPD exacerbations. CONCLUSIONS Data-driven analysis identifies four lung function trajectories. Trajectory membership has a genetic basis and is associated with distinct lung structural abnormalities.
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Affiliation(s)
| | - Peter J. Castaldi
- Channing Division of Network Medicine
- Divison of General Medicine, and
| | - Michael H. Cho
- Channing Division of Network Medicine
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts
| | - Craig P. Hersh
- Channing Division of Network Medicine
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts
| | - Farbod N. Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts
| | | | | | | | - David Sparrow
- VA Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and
| | - Jennifer G. Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Edwin K. Silverman
- Channing Division of Network Medicine
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts
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Román KLL, de La Bruere I, Onieva J, Andresen L, Holsting JQ, Rahaghi FN, Macía I, González Ballester MA, José Estepar RS. 3D Pulmonary Artery Segmentation from CTA Scans Using Deep Learning with Realistic Data Augmentation. ACTA ACUST UNITED AC 2018; 11040:225-237. [PMID: 32494780 DOI: 10.1007/978-3-030-00946-5_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The characterization of the vasculature in the mediastinum, more specifically the pulmonary artery, is of vital importance for the evaluation of several pulmonary vascular diseases. Thus, the goal of this study is to automatically segment the pulmonary artery (PA) from computed tomography angiography images, which opens up the opportunity for more complex analysis of the evolution of the PA geometry in health and disease and can be used in complex fluid mechanics models or individualized medicine. For that purpose, a new 3D convolutional neural network architecture is proposed, which is trained on images coming from different patient cohorts. The network makes use a strong data augmentation paradigm based on realistic deformations generated by applying principal component analysis to the deformation fields obtained from the affine registration of several datasets. The network is validated on 91 datasets by comparing the automatic segmentations with semi-automatically delineated ground truths in terms of mean Dice and Jaccard coefficients and mean distance between surfaces, which yields values of 0.89, 0.80 and 1.25 mm, respectively. Finally, a comparison against a Unet architecture is also included.
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Affiliation(s)
- Karen López-Linares Román
- Vicomtech Foundation and Biodonostia, San Sebastián, Spain.,BCN Medtech, Universitat Pompeu Fabra, Barcelona, Spain.,Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Isaac de La Bruere
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jorge Onieva
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Lasse Andresen
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jakob Qvortrup Holsting
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Iván Macía
- Vicomtech Foundation and Biodonostia, San Sebastián, Spain
| | | | - Raúl San José Estepar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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36
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Ash SY, Harmouche R, Ross JC, Diaz AA, Rahaghi FN, Vegas Sanchez-Ferrero G, Putman RK, Hunninghake GM, Onieva Onieva J, Martinez FJ, Choi AM, Bowler RP, Lynch DA, Hatabu H, Bhatt SP, Dransfield MT, Wells JM, Rosas IO, San Jose Estepar R, Washko GR. Interstitial Features at Chest CT Enhance the Deleterious Effects of Emphysema in the COPDGene Cohort. Radiology 2018; 288:600-609. [PMID: 29869957 PMCID: PMC6069608 DOI: 10.1148/radiol.2018172688] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 12/28/2022]
Abstract
Purpose To determine if interstitial features at chest CT enhance the effect of emphysema on clinical disease severity in smokers without clinical pulmonary fibrosis. Materials and Methods In this retrospective cohort study, an objective CT analysis tool was used to measure interstitial features (reticular changes, honeycombing, centrilobular nodules, linear scar, nodular changes, subpleural lines, and ground-glass opacities) and emphysema in 8266 participants in a study of chronic obstructive pulmonary disease (COPD) called COPDGene (recruited between October 2006 and January 2011). Additive differences in patients with emphysema with interstitial features and in those without interstitial features were analyzed by using t tests, multivariable linear regression, and Kaplan-Meier analysis. Multivariable linear and Cox regression were used to determine if interstitial features modified the effect of continuously measured emphysema on clinical measures of disease severity and mortality. Results Compared with individuals with emphysema alone, those with emphysema and interstitial features had a higher percentage predicted forced expiratory volume in 1 second (absolute difference, 6.4%; P < .001), a lower percentage predicted diffusing capacity of lung for carbon monoxide (DLCO) (absolute difference, 7.4%; P = .034), a 0.019 higher right ventricular-to-left ventricular (RVLV) volume ratio (P = .029), a 43.2-m shorter 6-minute walk distance (6MWD) (P < .001), a 5.9-point higher St George's Respiratory Questionnaire (SGRQ) score (P < .001), and 82% higher mortality (P < .001). In addition, interstitial features modified the effect of emphysema on percentage predicted DLCO, RVLV volume ratio, 6WMD, SGRQ score, and mortality (P for interaction < .05 for all). Conclusion In smokers, the combined presence of interstitial features and emphysema was associated with worse clinical disease severity and higher mortality than was emphysema alone. In addition, interstitial features enhanced the deleterious effects of emphysema on clinical disease severity and mortality.
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Affiliation(s)
- Samuel Y. Ash
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Rola Harmouche
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - James C. Ross
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Alejandro A. Diaz
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Farbod N. Rahaghi
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Rachel K. Putman
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Gary M. Hunninghake
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Jorge Onieva Onieva
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Fernando J. Martinez
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Augustine M. Choi
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Russell P. Bowler
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - David A. Lynch
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Hiroto Hatabu
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Surya P. Bhatt
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Mark T. Dransfield
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - J. Michael Wells
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Ivan O. Rosas
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Raul San Jose Estepar
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - George R. Washko
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - for the COPDGene Investigators
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
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Ash SY, Rahaghi FN, Come CE, Ross JC, Colon AG, Cardet-Guisasola JC, Dunican EM, Bleecker ER, Castro M, Fahy JV, Fain SB, Gaston BM, Hoffman EA, Jarjour NN, Mauger DT, Wenzel SE, Levy BD, San Jose Estepar R, Israel E. Pruning of the Pulmonary Vasculature in Asthma. The Severe Asthma Research Program (SARP) Cohort. Am J Respir Crit Care Med 2018; 198:39-50. [PMID: 29672122 PMCID: PMC6034125 DOI: 10.1164/rccm.201712-2426oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/19/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Loss of the peripheral pulmonary vasculature, termed vascular pruning, is associated with disease severity in patients with chronic obstructive pulmonary disease. OBJECTIVES To determine if pulmonary vascular pruning is associated with asthma severity and exacerbations. METHODS We measured the total pulmonary blood vessel volume (TBV) and the blood vessel volume of vessels less than 5 mm2 in cross-sectional area (BV5) and of vessels less than 10 mm2 (BV10) in cross-sectional area on noncontrast computed tomographic scans of participants from the Severe Asthma Research Program. Lower values of the BV5 to TBV ratio (BV5/TBV) and the BV10 to TBV ratio (BV10/TBV) represented vascular pruning (loss of the peripheral pulmonary vasculature). MEASUREMENTS AND MAIN RESULTS Compared with healthy control subjects, patients with severe asthma had more pulmonary vascular pruning. Among those with asthma, those with poor asthma control had more pruning than those with well-controlled disease. Pruning of the pulmonary vasculature was also associated with lower percent predicted FEV1 and FVC, greater peripheral and sputum eosinophilia, and higher BAL serum amyloid A/lipoxin A4 ratio but not with low-attenuation area or with sputum neutrophilia. Compared with individuals with less pruning, individuals with the most vascular pruning had 150% greater odds of reporting an asthma exacerbation (odds ratio, 2.50; confidence interval, 1.05-5.98; P = 0.039 for BV10/TBV) and reported 45% more asthma exacerbations during follow-up (incidence rate ratio, 1.45; confidence interval, 1.02-2.06; P = 0.036 for BV10/TBV). CONCLUSIONS Pruning of the peripheral pulmonary vasculature is associated with asthma severity, control, and exacerbations, and with lung function and eosinophilia.
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Affiliation(s)
- Samuel Y. Ash
- Division of Pulmonary and Critical Care Medicine and
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Farbod N. Rahaghi
- Division of Pulmonary and Critical Care Medicine and
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Carolyn E. Come
- Division of Pulmonary and Critical Care Medicine and
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - James C. Ross
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Alysha G. Colon
- College of Medicine, University of Florida, Gainesville, Florida
| | | | - Eleanor M. Dunican
- St. Vincent’s University Hospital, University College Dublin, Dublin, Ireland
| | - Eugene R. Bleecker
- Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, Arizona
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, Missouri
| | - John V. Fahy
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California
| | - Sean B. Fain
- Department of Medical Physics
- Department of Radiology
- Department of Biomedical Engineering, and
| | - Benjamin M. Gaston
- Division of Pediatric Allergy/Immunology and
- Division of Pediatric Pulmonology, Rainbow Babies and Children’s Hospital and Cleveland Medical Center, Cleveland, Ohio
| | - Eric A. Hoffman
- Department of Radiology
- Department of Biomedical Engineering, and
- Department of Medicine, University of Iowa, Iowa City, Iowa
| | - Nizar N. Jarjour
- Division of Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, Wisconsin
| | - David T. Mauger
- Division of Biostatistics and Bioinformatics, Eberly College of Science, Penn State University, University Park, Pennsylvania; and
| | - Sally E. Wenzel
- Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce D. Levy
- Division of Pulmonary and Critical Care Medicine and
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine and
| | - SARP Investigators
- Division of Pulmonary and Critical Care Medicine and
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
- College of Medicine, University of Florida, Gainesville, Florida
- Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, Florida
- St. Vincent’s University Hospital, University College Dublin, Dublin, Ireland
- Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, Arizona
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, Missouri
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California
- Department of Medical Physics
- Department of Radiology
- Department of Biomedical Engineering, and
- Division of Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, Wisconsin
- Division of Pediatric Allergy/Immunology and
- Division of Pediatric Pulmonology, Rainbow Babies and Children’s Hospital and Cleveland Medical Center, Cleveland, Ohio
- Department of Radiology
- Department of Biomedical Engineering, and
- Department of Medicine, University of Iowa, Iowa City, Iowa
- Division of Biostatistics and Bioinformatics, Eberly College of Science, Penn State University, University Park, Pennsylvania; and
- Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
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38
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Bhatt SP, Vegas-Sánchez-Ferrero G, Rahaghi FN, MacLean ES, Gonzalez-Serrano G, Come CE, Kinney GL, Hokanson JE, Budoff MJ, Cuttica MJ, Wells JM, Estépar RSJ, Washko GR. Cardiac Morphometry on Computed Tomography and Exacerbation Reduction with β-Blocker Therapy in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 196:1484-1488. [PMID: 28441027 DOI: 10.1164/rccm.201702-0399le] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Surya P Bhatt
- 1 University of Alabama at Birmingham Birmingham, Alabama
| | | | | | | | | | | | - Gregory L Kinney
- 3 University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - John E Hokanson
- 3 University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - Matthew J Budoff
- 4 Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Los Angeles, California and
| | - Michael J Cuttica
- 5 Northwestern University Feinberg School of Medicine Chicago, Illinois
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39
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Diaz AA, Rahaghi FN, Doyle TJ, Young TP, Maclean ES, Martinez CH, San José Estépar R, Guerra S, Tesfaigzi Y, Rosas IO, Washko GR, Wilson DO. Differences in Respiratory Symptoms and Lung Structure Between Hispanic and Non-Hispanic White Smokers: A Comparative Study. Chronic Obstr Pulm Dis 2017; 4:297-304. [PMID: 29354674 DOI: 10.15326/jcopdf.4.4.2017.0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Prior studies have demonstrated that U.S. Hispanic smokers have a lower risk of decline in lung function and chronic obstructive pulmonary disease (COPD) compared with non-Hispanic whites (NHW). This suggests there might be racial-ethnic differences in susceptibility in cigarette smoke-induced respiratory symptoms, lung parenchymal destruction, and airway and vascular disease, as well as in extra-pulmonary manifestations of COPD. Therefore, we aimed to explore respiratory symptoms, lung function, and pulmonary and extra-pulmonary structural changes in Hispanic and NHW smokers. Methods: We compared respiratory symptoms, lung function, and computed tomography (CT) measures of emphysema-like tissue, airway disease, the branching generation number (BGN) to reach a 2-mm-lumen-diameter airway, and vascular pruning as well as muscle and fat mass between 39 Hispanic and 39 sex-, age- and smoking exposure-matched NHW smokers. Results: Hispanic smokers had higher odds of dyspnea than NHW after adjustment for COPD and asthma statuses (odds ratio[OR] = 2.96; 95% confidence interval [CI] 1.09-8.04), but no significant differences were found in lung function and CT measurements. Conclusions: While lung function and CT measures of the lung structure were similar, dyspnea is reported more frequently by Hispanic than matched-NHW smokers. It seems to be an impossible puzzle but it's easy to solve a Rubik' Cube using a few algorithms.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas P Young
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erick S Maclean
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor
| | - Raul San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stefano Guerra
- Asthma and Airway Disease Research Center and Department of Medicine, University of Arizona, Tucson; and ISGlobal CREAL and Pompeu Fabra University, Barcelona, Spain
| | | | - Ivan O Rosas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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40
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Rahaghi FN, Vegas-Sanchez-Ferrero G, Minhas JK, Come CE, De La Bruere I, Wells JM, González G, Bhatt SP, Fenster BE, Diaz AA, Kohli P, Ross JC, Lynch DA, Dransfield MT, Bowler RP, Ledesma-Carbayo MJ, San José Estépar R, Washko GR. Ventricular Geometry From Non-contrast Non-ECG-gated CT Scans: An Imaging Marker of Cardiopulmonary Disease in Smokers. Acad Radiol 2017; 24:594-602. [PMID: 28215632 DOI: 10.1016/j.acra.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Imaging-based assessment of cardiovascular structure and function provides clinically relevant information in smokers. Non-cardiac-gated thoracic computed tomographic (CT) scanning is increasingly leveraged for clinical care and lung cancer screening. We sought to determine if more comprehensive measures of ventricular geometry could be obtained from CT using an atlas-based surface model of the heart. MATERIALS AND METHODS Subcohorts of 24 subjects with cardiac magnetic resonance imaging (MRI) and 262 subjects with echocardiography were identified from COPDGene, a longitudinal observational study of smokers. A surface model of the heart was manually initialized, and then automatically optimized to fit the epicardium for each CT. Estimates of right and left ventricular (RV and LV) volume and free-wall curvature were then calculated and compared to structural and functional metrics obtained from MRI and echocardiograms. RESULTS CT measures of RV dimension and curvature correlated with similar measures obtained using MRI. RV and LV volume obtained from CT inversely correlated with echocardiogram-based estimates of RV systolic pressure using tricuspid regurgitation jet velocity and LV ejection fraction respectively. Patients with evidence of RV or LV dysfunction on echocardiogram had larger RV and LV dimensions on CT. Logistic regression models based on demographics and ventricular measures from CT had an area under the curve of >0.7 for the prediction of elevated right ventricular systolic pressure and ventricular failure. CONCLUSIONS These data suggest that non-cardiac-gated, non-contrast-enhanced thoracic CT scanning may provide insight into cardiac structure and function in smokers.
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Rahaghi FN, Ross JC, Agarwal M, González G, Come CE, Diaz AA, Vegas-Sánchez-Ferrero G, Hunsaker A, San José Estépar R, Waxman AB, Washko GR. Pulmonary vascular morphology as an imaging biomarker in chronic thromboembolic pulmonary hypertension. Pulm Circ 2016; 6:70-81. [PMID: 27162616 PMCID: PMC4860553 DOI: 10.1086/685081] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) have morphologic changes to the pulmonary vasculature. These include pruning of the distal vessels, dilation of the proximal vessels, and increased vascular tortuosity. Advances in image processing and computer vision enable objective detection and quantification of these processes in clinically acquired computed tomographic (CT) scans. Three-dimensional reconstructions of the pulmonary vasculature were created from the CT angiograms of 18 patients with CTEPH diagnosed using imaging and hemodynamics as well as 15 control patients referred to our Dyspnea Clinic and found to have no evidence of pulmonary vascular disease. Compared to controls, CTEPH patients exhibited greater pruning of the distal vasculature (median density of small-vessel volume: 2.7 [interquartile range (IQR): 2.5-3.0] vs. 3.2 [3.0-3.8]; P = 0.008), greater dilation of proximal arteries (median fraction of blood in large arteries: 0.35 [IQR: 0.30-0.41] vs. 0.23 [0.21-0.31]; P = 0.0005), and increased tortuosity in the pulmonary arterial tree (median: 4.92% [IQR: 4.85%-5.21%] vs. 4.63% [4.39%-4.92%]; P = 0.004). CTEPH was not associated with dilation of proximal veins or increased tortuosity in the venous system. Distal pruning of the vasculature was correlated with the cardiac index (R = 0.51, P = 0.04). Quantitative models derived from CT scans can be used to measure changes in vascular morphology previously described subjectively in CTEPH. These measurements are also correlated with invasive metrics of pulmonary hemodynamics, suggesting that they may be used to assess disease severity. Further work in a larger cohort may enable the use of such measures as a biomarker for diagnostic, phenotyping, and prognostic purposes.
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Affiliation(s)
- F N Rahaghi
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J C Ross
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - M Agarwal
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - G González
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - C E Come
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A A Diaz
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - A Hunsaker
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - R San José Estépar
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - A B Waxman
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - G R Washko
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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42
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Vegas-Sanchez-Ferrero G, Washko G, Rahaghi FN, Ledesma-Carbayo MJ, Estépar RSJ. DERIVATION OF A TEST STATISTIC FOR EMPHYSEMA QUANTIFICATION. Proc IEEE Int Symp Biomed Imaging 2016; 2016:1269-1273. [PMID: 27974952 PMCID: PMC5153356 DOI: 10.1109/isbi.2016.7493498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Density masking is the de-facto quantitative imaging phenotype for emphysema that is widely used by the clinical community. Density masking defines the burden of emphysema by a fixed threshold, usually between -910 HU and -950 HU, that has been experimentally validated with histology. In this work, we formalized emphysema quantification by means of statistical inference. We show that a non-central Gamma is a good approximation for the local distribution of image intensities for normal and emphysema tissue. We then propose a test statistic in terms of the sample mean of a truncated non-central Gamma random variable. Our results show that this approach is well-suited for the detection of emphysema and superior to standard density masking. The statistical method was tested in a dataset of 1337 samples obtained from 9 different scanner models in subjects with COPD. Results showed an increase of 17% when compared to the density masking approach, and an overall accuracy of 94.09%.
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Affiliation(s)
- Gonzalo Vegas-Sanchez-Ferrero
- Applied Chest Imaging Lab., Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
| | - George Washko
- Applied Chest Imaging Lab., Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Farbod N Rahaghi
- Applied Chest Imaging Lab., Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - R San José Estépar
- Applied Chest Imaging Lab., Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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43
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Wells JM, Iyer AS, Rahaghi FN, Bhatt SP, Gupta H, Denney TS, Lloyd SG, Dell'Italia LJ, Nath H, Estepar RSJ, Washko GR, Dransfield MT. Pulmonary artery enlargement is associated with right ventricular dysfunction and loss of blood volume in small pulmonary vessels in chronic obstructive pulmonary disease. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002546. [PMID: 25855668 DOI: 10.1161/circimaging.114.002546] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease causes significant morbidity and concomitant pulmonary vascular disease and cardiac dysfunction are associated with poor prognosis. Computed tomography-detected relative pulmonary artery (PA) enlargement defined as a PA to ascending aorta diameter ratio >1 (PA:A>1) is a marker for pulmonary hypertension and predicts chronic obstructive pulmonary disease exacerbations. However, little is known about the relationship between the PA:A ratio, pulmonary blood volume, and cardiac function. METHODS AND RESULTS A single-center prospective cohort study of patients with chronic obstructive pulmonary disease was conducted. Clinical characteristics and computed tomography metrics, including the PA:A and pulmonary blood vessel volume, were measured. Ventricular functions, volumes, and dimensions were measured by cine cardiac MRI with 3-dimensional analysis. Linear regression examined the relationships between clinical characteristics, computed tomography and cardiac MRI metrics, and 6-minute walk distance. Twenty-four patients were evaluated and those with PA:A>1 had higher right ventricular (RV) end-diastolic and end-systolic volume indices accompanied by lower RV ejection fraction (52±7% versus 60±9%; P=0.04). The PA:A correlated inversely with total intraparenchymal pulmonary blood vessel volume and the volume of distal vessels with a cross-sectional area of <5 mm(2). Lower forced expiratory volume, PA:A>1, and hyperinflation correlated with reduced RV ejection fraction. Both PA diameter and reduced RV ejection fraction were independently associated with reduced 6-minute walk distance. CONCLUSIONS The loss of blood volume in distal pulmonary vessels is associated with PA enlargement on computed tomography. Cardiac MRI detects early RV dysfunction and remodeling in nonsevere chronic obstructive pulmonary disease patients with a PA:A>1. Both RV dysfunction and PA enlargement are independently associated with reduced walk distance. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00608764.
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Affiliation(s)
- J Michael Wells
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.).
| | - Anand S Iyer
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Farbod N Rahaghi
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Surya P Bhatt
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Himanshu Gupta
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Thomas S Denney
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Steven G Lloyd
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Louis J Dell'Italia
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Hrudaya Nath
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Raul San Jose Estepar
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - George R Washko
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
| | - Mark T Dransfield
- From the Birmingham VA Medical Center, AL (J.M.W., H.G., S.G.L., L.J.D., M.T.D.); Department of Medicine (J.M.W., A.S.I., S.P.B., H.G., S.G.L., L.J.D., M.T.D.), Division of Pulmonary, Allergy, and Critical Care, Lung Health Center (J.M.W., S.P.B., M.T.D.), Division of Cardiovascular Disease (H.G., S.G.L., L.J.D.), and Department of Radiology (H.N.), University of Alabama at Birmingham; Division of Pulmonary and Critical Care Medicine (F.N.R., G.R.W.) and Department of Radiology, Harvard Medical School (R.S.J.E.), Brigham and Women's Hospital, Boston, MA; and Department of Electrical and Computer Engineering, Auburn University, AL (T.S.D.)
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Diaz AA, Rahaghi FN, Ross JC, Harmouche R, Tschirren J, San José Estépar R, Washko GR. Understanding the contribution of native tracheobronchial structure to lung function: CT assessment of airway morphology in never smokers. Respir Res 2015; 16:23. [PMID: 25848985 PMCID: PMC4335784 DOI: 10.1186/s12931-015-0181-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background Computed tomographic (CT) airway lumen narrowing is associated with lower lung function. Although volumetric CT measures of airways (wall volume [WV] and lumen volume [LV]) compared to cross sectional measures can more accurately reflect bronchial morphology, data of their use in never smokers is scarce. We hypothesize that native tracheobronchial tree morphology as assessed by volumetric CT metrics play a significant role in determining lung function in normal subjects. We aimed to assess the relationships between airway size, the projected branching generation number (BGN) to reach airways of <2mm lumen diameter –the site for airflow obstruction in smokers- and measures of lung function including forced expiratory volume in 1 second (FEV1) and forced expiratory flow between 25% and 75% of vital capacity (FEF 25–75). Methods We assessed WV and LV of segmental and subsegmental airways from six bronchial paths as well as lung volume on CT scans from 106 never smokers. We calculated the lumen area ratio of the subsegmental to segmental airways and estimated the projected BGN to reach a <2mm-lumen-diameter airway assuming a dichotomized tracheobronchial tree model. Regression analysis was used to assess the relationships between airway size, BGN, FEF 25–75, and FEV1. Results We found that in models adjusted for demographics, LV and WV of segmental and subsegmental airways were directly related to FEV1 (P <0.05 for all the models). In adjusted models for age, sex, race, LV and lung volume or height, the projected BGN was directly associated with FEF 25–75 and FEV1 (P = 0.001) where subjects with lower FEV1 had fewer calculated branch generations between the subsegmental bronchus and small airways. There was no association between airway lumen area ratio and lung volume. Conclusion We conclude that in never smokers, those with smaller central airways had lower airflow and those with lower airflow had less parallel airway pathways independent of lung size. These findings suggest that variability in the structure of the tracheobronchial tree may influence the risk of developing clinically relevant smoking related airway obstruction. Electronic supplementary material The online version of this article (doi:10.1186/s12931-015-0181-y) contains supplementary material, which is available to authorized users.
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Rahaghi FN, Come CE, Ross J, Harmouche R, Diaz AA, Estepar RSJ, Washko G. Morphologic Response of the Pulmonary Vasculature to Endoscopic Lung Volume Reduction. Chronic Obstr Pulm Dis 2015; 2:214-222. [PMID: 26587564 DOI: 10.15326/jcopdf.2.3.2014.0164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Endoscopic Lung Volume Reduction has been used to reduce lung hyperinflation in selected patients with severe emphysema. Little is known about the effect of this procedure on the intraparenchymal pulmonary vasculature. In this study we used CT based vascular reconstruction to quantify the effect of the procedure on the pulmonary vasculature. METHODS Intraparenchymal vasculature was reconstructed and quantified in 12 patients with CT scans at baseline and 12 weeks following bilateral introduction of sealants in the upper lobes. The volume of each lung and each lobe was measured, and the vascular volume profile was calculated for both lower lobes. The detected vasculature was further labeled manually as arterial or venous in the right lower lobe. RESULTS There was an increase in the volume of the lower lobes (3.14L to 3.25L, p=0.0005). There was an increase in BV5, defined as the volume of blood vessels with cross sectional area of less than 5mm2, (53.2ml to 57.9ml, p=0.03). This was found to be correlated with the increase in lower lobe volumes (R=0.65, p=0.02). The changes appear to be symmetric for veins and arteries with a correlation coefficient of 0.87 and a slope of near identity. CONCLUSION In the subjects studied, there was an increase, from baseline, in BV5 in the lower lobes that correlated with the change in the volume of the lower lobes. The change appeared to be symmetric for both arteries and veins. The study illustrates the use of intraparenchymal pulmonary vascular reconstruction to study morphologic changes in response to interventions.
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Affiliation(s)
- Farbod N Rahaghi
- Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115
| | - Carolyn E Come
- Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115
| | - James Ross
- Deparment of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216
| | - Rola Harmouche
- Deparment of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216
| | - Alejandro A Diaz
- Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115
| | - Raul San Jose Estepar
- Deparment of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216, Boston MA 02215
| | - George Washko
- Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115
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Rahaghi FN, Lazea D, Dihya S, San José Estépar R, Bueno R, Sugarbaker D, Frendl G, Washko GR. Preoperative pulmonary vascular morphology and its relationship to postpneumonectomy hemodynamics. Acad Radiol 2014; 21:704-10. [PMID: 24809312 DOI: 10.1016/j.acra.2014.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Pulmonary edema and pulmonary hypertension are postsurgical complications of pneumonectomy that may represent the remaining pulmonary vasculature's inability to accommodate the entirety of the cardiac output. Quantification of the aggregate pulmonary vascular cross-sectional area (CSA) has been used to study the development of pulmonary vascular disease in smokers. In this study, we applied this technique to demonstrate the potential utility of pulmonary vascular quantification in surgical risk assessment. Our hypothesis was that those subjects with the lowest aggregate vascular CSA in the nonoperative lung would be most likely to have elevated pulmonary vascular pressures in the postoperative period. MATERIALS AND METHODS A total of 61 subjects with postoperative hemodynamics and adequate imaging were identified from 159 patients undergoing pneumonectomies for mesothelioma. The total CSA of blood vessels perpendicular to the plane of computed tomographic (CT) scan slices was computed for blood vessels <5 mm(2) (CSA 5 mm). This measurement expressed as a percentage of lung parenchyma area (CSA 5%) was compared to postoperative hemodynamic measurements obtained by right heart catheterization. RESULTS In patients where a contrasted CT scan was used (n = 26), CSA 5% was correlated with postoperative day 0 minimum cardiac index (R = 0.37, P = .03) but not with the maximum pulmonary arterial pressures. In patients with noncontrast CT scans (n = 35), CSA 5% was inversely correlated with postoperative day 0 maximum pulmonary arterial pressures (R = 0.43, P = .03) but not with the minimum cardiac index. The preoperative perfusion fraction of the nonsurgical lung did not correlate with postoperative hemodynamics. CONCLUSIONS CSA of pulmonary vasculature with an area ≤5 mm(2) has potential in estimating the ability of pulmonary vascular bed to accommodate postsurgical changes in pneumonectomy.
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Abstract
Measurement of blood glucose concentration is central to the diagnosis and treatment of diabetes. Although there are large numbers of historic glucose measurements in individuals with diabetes, until recently there have been very few data sets that were recorded continuously or sampled frequently enough to reveal intrinsic blood glucose dynamics, or the change in blood glucose with time. There have even fewer such recordings from individuals not having diabetes to serve as a therapeutic target. As a result, blood glucose dynamics have generally not been used in the diagnosis or treatment of the disease. Although present blood glucose monitoring is based largely on discrete measurements, future monitoring will likely focus on analysis of blood glucose excursions. New measurements are now being obtained, and there is a need for new methods of analysis to extract the maximal information from the data. Several approaches are demonstrated here for characterization of blood glucose dynamics, and a patient profiling system is proposed. An example of new insights is the observation that there are four time scales of blood glucose variations in individuals without diabetes, and these time scales are modified or lost in diabetes.
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Affiliation(s)
- Farbod N Rahaghi
- Department of Bioengineering, University of California San Diego, La Jolla, California 92093-0412, USA
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