Pulmonary arterial enlargement and acute exacerbations of COPD

J. Michael Wells, George R. Washko, MeiLan K. Han, Naseer Abbas, Hrudaya Nath, A. James Mamary, Elizabeth Regan, William C. Bailey, Fernando J. Martinez, Elizabeth Westfall, Terri L Beaty, Douglas Curran-Everett, Jeffrey L. Curtis, John E. Hokanson, David A. Lynch, Barry J. Make, James D. Crapo, Edwin K. Silverman, Russell P. Bowler, Mark T. Dransfield

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exacerbations, though pulmonary vascular abnormalities also occur early in the course of the disease. We hypothesized that a computed tomographic (CT) metric of pulmonary vascular disease (pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the diameter of the aorta [PA:A ratio] of >1) would be associated with severe COPD exacerbations. METHODS:We conducted a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between a PA:A ratio of more than 1 and a history at enrollment of severe exacerbations requiring hospitalization and then examined the usefulness of the ratio as a predictor of these events in a longitudinal follow-up of this cohort, as well as in an external validation cohort. We used logistic-regression and zero-inflated negative binomial regression analyses and adjusted for known risk factors for exacerbation. RESULTS:Multivariate logistic-regression analysis showed a significant association between a PA:A ratio of more than 1 and a history of severe exacerbations at the time of enrollment in the trial (odds ratio, 4.78; 95% confidence interval [CI], 3.43 to 6.65; P1), as detected by CT, was associated with severe exacerbations of COPD. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov numbers, NCT00608764 and NCT00292552.)

Original languageEnglish (US)
Pages (from-to)913-921
Number of pages9
JournalNew England Journal of Medicine
Volume367
Issue number10
DOIs
StatePublished - Sep 6 2012

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Chronic Obstructive Pulmonary Disease
Lung
Pulmonary Artery
Hospitalization
Logistic Models
Regression Analysis
National Heart, Lung, and Blood Institute (U.S.)
Vascular Diseases
Pulmonary Hypertension
Lung Diseases
Multicenter Studies
Blood Vessels
Aorta
Disease Progression
History
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wells, J. M., Washko, G. R., Han, M. K., Abbas, N., Nath, H., Mamary, A. J., ... Dransfield, M. T. (2012). Pulmonary arterial enlargement and acute exacerbations of COPD. New England Journal of Medicine, 367(10), 913-921. https://doi.org/10.1056/NEJMoa1203830

Pulmonary arterial enlargement and acute exacerbations of COPD. / Wells, J. Michael; Washko, George R.; Han, MeiLan K.; Abbas, Naseer; Nath, Hrudaya; Mamary, A. James; Regan, Elizabeth; Bailey, William C.; Martinez, Fernando J.; Westfall, Elizabeth; Beaty, Terri L; Curran-Everett, Douglas; Curtis, Jeffrey L.; Hokanson, John E.; Lynch, David A.; Make, Barry J.; Crapo, James D.; Silverman, Edwin K.; Bowler, Russell P.; Dransfield, Mark T.

In: New England Journal of Medicine, Vol. 367, No. 10, 06.09.2012, p. 913-921.

Research output: Contribution to journalArticle

Wells, JM, Washko, GR, Han, MK, Abbas, N, Nath, H, Mamary, AJ, Regan, E, Bailey, WC, Martinez, FJ, Westfall, E, Beaty, TL, Curran-Everett, D, Curtis, JL, Hokanson, JE, Lynch, DA, Make, BJ, Crapo, JD, Silverman, EK, Bowler, RP & Dransfield, MT 2012, 'Pulmonary arterial enlargement and acute exacerbations of COPD', New England Journal of Medicine, vol. 367, no. 10, pp. 913-921. https://doi.org/10.1056/NEJMoa1203830
Wells JM, Washko GR, Han MK, Abbas N, Nath H, Mamary AJ et al. Pulmonary arterial enlargement and acute exacerbations of COPD. New England Journal of Medicine. 2012 Sep 6;367(10):913-921. https://doi.org/10.1056/NEJMoa1203830
Wells, J. Michael ; Washko, George R. ; Han, MeiLan K. ; Abbas, Naseer ; Nath, Hrudaya ; Mamary, A. James ; Regan, Elizabeth ; Bailey, William C. ; Martinez, Fernando J. ; Westfall, Elizabeth ; Beaty, Terri L ; Curran-Everett, Douglas ; Curtis, Jeffrey L. ; Hokanson, John E. ; Lynch, David A. ; Make, Barry J. ; Crapo, James D. ; Silverman, Edwin K. ; Bowler, Russell P. ; Dransfield, Mark T. / Pulmonary arterial enlargement and acute exacerbations of COPD. In: New England Journal of Medicine. 2012 ; Vol. 367, No. 10. pp. 913-921.
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T1 - Pulmonary arterial enlargement and acute exacerbations of COPD

AU - Wells, J. Michael

AU - Washko, George R.

AU - Han, MeiLan K.

AU - Abbas, Naseer

AU - Nath, Hrudaya

AU - Mamary, A. James

AU - Regan, Elizabeth

AU - Bailey, William C.

AU - Martinez, Fernando J.

AU - Westfall, Elizabeth

AU - Beaty, Terri L

AU - Curran-Everett, Douglas

AU - Curtis, Jeffrey L.

AU - Hokanson, John E.

AU - Lynch, David A.

AU - Make, Barry J.

AU - Crapo, James D.

AU - Silverman, Edwin K.

AU - Bowler, Russell P.

AU - Dransfield, Mark T.

PY - 2012/9/6

Y1 - 2012/9/6

N2 - BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exacerbations, though pulmonary vascular abnormalities also occur early in the course of the disease. We hypothesized that a computed tomographic (CT) metric of pulmonary vascular disease (pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the diameter of the aorta [PA:A ratio] of >1) would be associated with severe COPD exacerbations. METHODS:We conducted a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between a PA:A ratio of more than 1 and a history at enrollment of severe exacerbations requiring hospitalization and then examined the usefulness of the ratio as a predictor of these events in a longitudinal follow-up of this cohort, as well as in an external validation cohort. We used logistic-regression and zero-inflated negative binomial regression analyses and adjusted for known risk factors for exacerbation. RESULTS:Multivariate logistic-regression analysis showed a significant association between a PA:A ratio of more than 1 and a history of severe exacerbations at the time of enrollment in the trial (odds ratio, 4.78; 95% confidence interval [CI], 3.43 to 6.65; P1), as detected by CT, was associated with severe exacerbations of COPD. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov numbers, NCT00608764 and NCT00292552.)

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