Aim
In chronic obstructive pulmonary disease (COPD), emphysema can lead to microscopic artery loss and pulmonary hypertension. Left heart dysfunction can lead to enlargement of distal pulmonary veins. Aims: To evaluate pulmonary artery/vein volume on CT and associate this with clinical parameters and mortality.
Methods
The artery-vein phenotyping analysis (AVX) was performed using the AI-based lung quantification platform LungQ (Thirona, The Netherlands). For this analysis we quantified large artery volume (diameter ?2mm, AVXLA) and small vein volume (diameter <2mm, AVXSV) in participants in the COPDGene study, normalized for body height. Normal AVXLA and AVXSV volumes were determined using never smokers (95th percentile). Baseline characteristics were compared between normal and abnormal groups using independent T-tests.
Results
7980 subjects included 77 never smokers. AVXSV>97.5 mm3/cm and AVXLA>263.9 mm3/cm were defined as abnormal. Subjects with increased AVXSV or AVXLA had higher 10y mortality compared to subjects with normal AVXSV and AVXLA (41.4% and 39.4% vs. 28.0%). Results on clinical parameters are shown in the table.
| Parameter | Normal AVXSV and AVXLA (n=6173) | High AVXSV** (n=970) | High AVXLA** (n=1294) |
| Male gender,% | 45.4% | 77.7%* | 85.4%* |
| Emphysema,% | 5.9±9.6% | 10.2±11.3%* | 9.8±10.9%* |
| FEV1%predicted | 77.0±24.9% | 70.7±28.7%* | 71.5±27.9%* |
| CAC score | 147±322 | 296±483* | 300±520* |
*p<.001 as compared to normal group **Overlap in 536 subjects
Conclusions
High AVXSV and AVXLA in subjects with COPD are associated with male gender, more emphysema, higher CAC scores and higher mortality. This may reflect left heart dysfunction and pulmonary artery hypertension.