Pulmonary artery enlargement and mortality risk in moderate to severe COPD: results from COPDGene.

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide [1]. Pulmonary hypertension (PH) has been associated with reduced survival among individuals with COPD [2] and is an independent risk factor for mortality following acute exacerbations of COPD (AECOPD) [3]. Measurement of the pulmonary artery to aorta (PA:A) ratio by computed tomography (CT) and assessment of PA enlargement (PA:A>1) outperforms echocardiography in identifying PH in severe COPD [4], and PA enlargement has been independently associated with risk for total and severe AECOPD in two large prospective COPD cohorts [5]. Studies of population-based [6] and non-COPD [7] cohorts have indicated an association between PA enlargement on CT and mortality. However, these studies did not include adjustment for other factors associated with COPD severity, known risk factors for COPD mortality, and risk factors for atherosclerotic cardiovascular disease (ASCVD), which is a major cause of mortality in COPD. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. LaFon reports grants from NIH, during the conduct of the study. Conflict of interest: Dr. Bhatt reports grants from NIH, during the conduct of the study; other from ProterixBio, personal fees from Sunovion, personal fees from GlaxoSmithKline, outside the submitted work. Conflict of interest: Dr. Labaki has nothing to disclose. Conflict of interest: Dr. Rahaghi has nothing to disclose. Conflict of interest: None Conflict of interest: Dr. Bowler has nothing to disclose. Conflict of interest: Dr. Regan has nothing to disclose. Conflict of interest: Related to the topic of COPD: Dr. Make reports funding from the NHLBI for the COPDGene study; grants and medical advisory boards from Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, and Sunovian; personal fees for DSMB from Spiration and Shire/Baxalta; CME personal fees from WebMD, National Jewish Health, American College of Chest Physicians, Projects in Knowledge, Hybrid Communications, SPIRE Learning, Ultimate Medical Academy, Catamount Medical, Eastern Pulmonary Society, Catamount Medical Communications Medscape, Eastern VA Medical Center, Academy Continued Healthcare Learning, and Mt. Sinai Medical Center; royalites from Up-To-Date; medical advisory boards from Novartis, Phillips, Third Pole, Science 24/7, and Vernoa; grants from Pearl; outside the submitted work. Conflict of interest: Dr. Crapo has nothing to disclose. Conflict of interest: Dr. San Jose Estepar reports grants from NIH, during the conduct of the study; grants from NIH, personal fees from Toshiba, personal fees from Boehringer Ingelheim, personal fees from Eolo Medical, outside the submitted work; and he is also a founder and co-owner of Quantitative Imaging Solutions which is a company that provides image based consulting and develops software to enable data sharing. Conflict of interest: Dr. Diaz reports grants from National Institues of Health, from Brigham and Women's Hospital, during the conduct of the study. Conflict of interest: Dr. Silverman reports grants from NIH, during the conduct of the study; grants and other from GlaxoSmithKline, outside the submitted work. Conflict of interest: Dr. Han reports grants from NIH, during the conduct of the study; personal fees from GSK, personal fees from BI, personal fees from Mylan, personal fees from AstraZeneca, other from Novartis, other from Sunovion, outside the submitted work. Conflict of interest: Dr. Hobbs has nothing to disclose. Conflict of interest: Dr. Cho reports grants from NIH, from null, during the conduct of the study; grants from GSK, personal fees from Genentech, outside the submitted work. Conflict of interest: Dr. Washko has nothing to disclose. Conflict of interest: Dr. Dransfield reports grants from NIH, during the conduct of the study; grants from Department of Defense , personal fees and other from Boehringer Ingelheim, personal fees and other from GlaxoSmithKline, other from Novartis, personal fees and other from AstraZeneca, other from Yungjin, personal fees and other from PneumRx/BTG, other from Pulmonx, personal fees from Genentech, other from Boston Scientific , personal fees from Quark Pharmaceuticals, grants from NIH, personal fees from Mereo, grants from American Lung Association, outside the submitted work. Conflict of interest: Dr. Wells reports grants from NIH/NHLBI, during the conduct of the study; grants from NIH/NCATS, grants from Bayer, grants and other from GSK, other from Boehringer Ingelheim, grants and other from Mereo BioPharma, other from Quintiles, other from PRA, outside the submitted work.