The Relationship between Small Pulmonary Vascular Alteration and Aortic Atherosclerosis in Chronic Obstructive Pulmonary Disease: Quantitative CT Analysis

doi:10.1016/j.acra.2010.08.013

Academic Radiology

Volume 18, Issue 1, January 2011, Pages 40-46

https://doi.org/10.1016/j.acra.2010.08.013 Get rights and content

Rationale and Objectives

The relationship between chronic obstructive pulmonary disease (COPD) and atherosclerosis has been suggested; this association may relate to systemic inflammation and endothelial dysfunction, which can lead to alteration of small pulmonary vessels. The relationship between atherosclerosis and small pulmonary vessel alteration, however, has not been assessed in COPD patients. We tested the hypothesis that the severity of thoracic aortic calcification measured by computed tomography (CT) would be associated with the total cross-sectional area of small pulmonary vessels (CSA) on CT images.

Materials and Methods

The study was approved by the institutional review board and was Health Insurance Portability and Accountability Act–compliant. Informed consent was waived. For 51 COPD patients enrolled in the National Heart, Lung, and Blood Institute Lung Tissue Research Consortium, we calculated the percentage of total CSAs of less than 5 mm² for the total lung area (%CSA<5). Thoracic aortic calcification, quantified by modified Agatston score, was measured. The correlations between thoracic aortic calcification score and %CSA<5, pulmonary function, and extent of emphysema were evaluated. Multiple linear regression analysis using aortic calcification score as the dependent outcome was also performed.

Results

The %CSA<5 had a significant negative correlation with the thoracic aortic calcification score (r = −0.566, P < .0001). Multiple linear regression analysis showed significant correlation between the aortic calcification score and %CSA<5 (P < .0001) independent of age, pack-years, extent of emphysema, and FEV1%.

Conclusions

Atherosclerosis, assessed by aortic calcification, is associated with the small pulmonary vascular alteration in COPD. Systemic inflammation and endothelial dysfunction may cause the close relationship between atherosclerosis and small pulmonary vessel alteration.

Section snippets

Subjects

We retrospectively evaluated CT scans and clinical data collected as part of the National Heart, Lung, and Blood Institute Lung Tissue Research Consortium (LTRC). Further information on LTRC is available on the website www.ltrcpublic.com. This retrospective study was approved by the institutional review board at our institution, and performed in compliance with the Health Insurance Portability and Accountability Act guidelines. All subjects gave written informed consent. Subjects were evaluated

Results

Subject characteristics, including the results of pulmonary function tests, are presented in Table 1. Seventy-nine patients were diagnosed with COPD and had CT data suitable for this study. Five patients were excluded because of having chronic heart failure, diabetes mellitus, or chronic renal failure. According to the CT exclusion criteria in this study, an additional 23 subjects were excluded because of obvious abnormal lung parenchymal lesions other than emphysema on CT images that were used

Discussion

In the present study, we showed that the thoracic aortic calcification score shows an inverse correlation with %CSA<5 in COPD patients. This indicates that vascular alteration is present in both systemic and pulmonary vessels in COPD, and that those severities are correlated. Several studies demonstrate that both pulmonary and systemic vascular alterations in patients with COPD closely relate to endothelial dysfunction and inflammation 15, 16, 17, 18, 19, 28, 29, 30. A recent study shows the

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: Supported by National Institutes of Health (Grants K23HL089353-01A1, U01 HL089856-0), and a grant from The Parker B. Francis Foundation.

View full text

Original investigationThe Relationship between Small Pulmonary Vascular Alteration and Aortic Atherosclerosis in Chronic Obstructive Pulmonary Disease: Quantitative CT Analysis

Rationale and Objectives

Materials and Methods

Results

Conclusions

Section snippets

Subjects

Results

Discussion

Chest

J Am Coll Cardiol

Atherosclerosis

Am J Cardiol

Am Heart J

Acad Radiol

Atherosclerosis

Acad Radiol

J Chin Med Assoc

Chest

Chest

Chest

Am J Med

Atherosclerosis

Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis

Thorax

C-reactive protein in patients with COPD, control smokers and non-smokers

Thorax

Circulating haemopoietic and endothelial progenitor cells are decreased in COPD

Eur Respir J

Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease

Circulation

C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease

Thorax

Hospitalizations and mortality in the Lung Health Study

Am J Respir Crit Care Med

TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease

N Engl J Med

The pathogenesis of atherosclerosis: a perspective for the 1990s

Nature

Atherosclerotic vascular disease conference: writing group iii: pathophysiology

Circulation

Atherosclerosis – an inflammatory disease

N Engl J Med

Endothelial dysfunction: a marker of atherosclerotic risk

Arterioscler Thromb Vasc Biol

Original investigation
The Relationship between Small Pulmonary Vascular Alteration and Aortic Atherosclerosis in Chronic Obstructive Pulmonary Disease: Quantitative CT Analysis